Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001298 | CT |
NPI | 1114591815 |
---|---|
Provider Name | Mrs. Ellen A Roseen |
First Address | Manchester, CT 06042-2004 |
Second Address | Manchester, CT 06042-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 17/05/2021 |