Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001696 | CT |
NPI | 1144720954 |
---|---|
Provider Name | Mr. Clifton J Brann |
First Address | Norwich, CT 06360-2173 |
Second Address | Norwich, CT 06360-2173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 17/03/2018 |