Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1604 | CT |
NPI | 1134547706 |
---|---|
Provider Name | Siobhan Burns |
First Address | Groton, CT 06340-6293 |
Second Address | New London, CT 06320-6398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 01/04/2014 |