Healthcare Provider Details

I. General information

NPI: 1275918948
Provider Name (Legal Business Name): FRANK CHARLES CARLONI L.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAWLEY LN SUITE 16
TRUMBULL CT
06611-5330
US

IV. Provider business mailing address

100 HAWLEY LN SUITE 16
TRUMBULL CT
06611-5330
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-9462
  • Fax: 203-380-9462
Mailing address:
  • Phone: 203-378-9462
  • Fax: 203-380-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number001118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: