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General NPI Number Information
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NPI Number | 1063484103
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Entity Type | Individual
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Provider Name | GEORGE RAYMOND STIMAC O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 125 BUCKLAND HILLS DR @ TARGET OPTICAL
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City | MANCHESTER
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State | CT
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Zip | 06042-8701
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Country | US
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Telephone | 860-327-0085
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Fax | 860-327-0087
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Provider Business Mailing Address
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Address Line | 35 DEREK LN
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City | WINDSOR
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State | CT
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Zip | 06095-1739
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Country | US
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Telephone | 860-683-4490
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002513
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License Number State | CT
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