Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 000552 | CT |
NPI | 1003032210 |
---|---|
Provider Name | Mr. E. Craig Fritz |
First Address | Branford, CT 06405-3126 |
Second Address | Branford, CT 06405-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |