Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1155 | CT |
NPI | 1205598786 |
---|---|
Provider Name | Luke R Nearine |
First Address | South Windham, CT 06266-1129 |
Second Address | Brooklyn, CT 06234-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2021 |
Last Update Date | 12/10/2021 |