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General NPI Number Information
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NPI Number | 1043462161
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Entity Type | Organization
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Legal Business Name | SONJA P. CARLETON, OPTICIAN
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 57 MAIN ST
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City | NEWPORT
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State | NH
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Zip | 03773-1519
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Country | US
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Telephone | 603-863-7770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 148 57 MAIN STREET
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City | NEWPORT
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State | NH
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Zip | 03773-0148
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Country | US
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Telephone | 603-863-7770
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR/MANAGER
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Name | MRS. SONJA PATRICIA CARLETON
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Credential | CERTIFIED OPTICIAN
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Telephone | 603-543-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 457
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License Number State | NH
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