Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1825 | CT |
NPI | 1124616826 |
---|---|
Provider Name | Ms. Hailey Olson Hicks |
First Address | Brooklyn, CT 06234-1823 |
Second Address | Brooklyn, CT 06234-1823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |