MEDICARE: GLENN T. BEMUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	001115	CT

General Provider Information

NPI Number	:	1659698660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN T. BEMUS

Provider Business Mailing Address
First Line	:	2480 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-2406
Country	:	US
Telephone Number	:	203-372-2010
Fax Number	:	203-372-2011

Provider Business Practice Location Address
First Line	:	2480 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-2406
Country	:	US
Telephone Number	:	203-372-2010
Fax Number	:	203-372-2011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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Directions to “ GLENN T. BEMUS ” Practice Location

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