Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 1035 | CT |
NPI | 1417176645 |
---|---|
Provider Name | Ms. Ginger Crowe |
First Address | Glastonbury, CT 06033-2061 |
Second Address | Glastonbury, CT 06033-2061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |