Healthcare Provider Details

I. General information

NPI: 1639936321
Provider Name (Legal Business Name): ERIK ROBERT DYKAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 CANDLEWOOD HILL RD
HIGGANUM CT
06441-4210
US

IV. Provider business mailing address

472 CANDLEWOOD HILL RD
HIGGANUM CT
06441-4210
US

V. Phone/Fax

Practice location:
  • Phone: 860-680-1756
  • Fax:
Mailing address:
  • Phone: 860-680-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: