Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001475 | CT |
NPI | 1083791495 |
---|---|
Provider Name | Patrick Joseph Moriarty |
First Address | Madison, CT 06443-2632 |
Second Address | Madison, CT 06443-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |