Healthcare Provider Details

I. General information

NPI: 1386534014
Provider Name (Legal Business Name): BETHANY GRACE ARABIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GREEN HOLLOW RD
DANIELSON CT
06239-3509
US

IV. Provider business mailing address

25 GREEN HOLLOW RD
DANIELSON CT
06239-3509
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-1588
  • Fax:
Mailing address:
  • Phone: 860-779-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number152W00000X
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: