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General NPI Number Information
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NPI Number | 1013428754
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Entity Type | Individual
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Provider Name | ALFREDO A ANGELES PURIAMAN LO
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Gender | Male
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 150 BARNUM AVENUE CUTOFF
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City | STRATFORD
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State | CT
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Zip | 06614-5111
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Country | US
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Telephone | 203-502-7637
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 BOSTON POST RD
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City | MILFORD
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State | CT
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Zip | 06460-2703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1752
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License Number State | CT
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