Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1768 | CT |
NPI | 1023597838 |
---|---|
Provider Name | Mr. Emmanuel Colon |
First Address | Hamden, CT 06518 |
Second Address | Hamden, CT 06518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 09/05/2019 |