Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 00857 | CT |
NPI | 1013017888 |
---|---|
Provider Name | Mr. Steven M Rapoport |
First Address | Waterford, CT 06385-2806 |
Second Address | Waterford, CT 06385-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4024683 | (05) | CT |
T22959 | (02) | CT |