Healthcare Provider Details

I. General information

NPI: 1992951750
Provider Name (Legal Business Name): MARIA FERNANDA VARELA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 COLT HWY
FARMINGTON CT
06032-2547
US

IV. Provider business mailing address

55 LINBROOK RD
WEST HARTFORD CT
06107-1228
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-0449
  • Fax:
Mailing address:
  • Phone: 617-733-7492
  • Fax: 617-733-7492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4660
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2848
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: