Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001647 | CT |
NPI | 1083022339 |
---|---|
Provider Name | Weverton Depaula |
First Address | Orange, CT 06477-3649 |
Second Address | Orange, CT 06477-3649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 31/07/2014 |