Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 000406 | CT |
NPI | 1083831937 |
---|---|
Provider Name | Mr. John G. Stepensky SR. |
First Address | New Britain, CT 06051 |
Second Address | New Britain, CT 06051-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 28/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100000406CT01 | BLUE CROSS BLUE SHIELD (01) | CT |
133452 | EYEMED (01) | CT |