Healthcare Provider Details

I. General information

NPI: 1932266558
Provider Name (Legal Business Name): ROBERT S. DUBIEL LO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 BURNSIDE AVE
EAST HARTFORD CT
06108
US

IV. Provider business mailing address

386 BURNSIDE AVE.
EAST HARTFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-5555
  • Fax: 860-528-6402
Mailing address:
  • Phone: 860-289-5555
  • Fax: 860-528-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberL0431
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1045
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number431
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: