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General NPI Number Information
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NPI Number | 1063595783
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD SUNDMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 FARMINGTON AVE WALMART VISION CENTER
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City | BRISTOL
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State | CT
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Zip | 06010-4701
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Country | US
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Telephone | 860-585-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 382 GILLETTE RD
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City | NEW HARTFORD
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State | CT
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Zip | 06057-2809
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Country | US
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Telephone | 860-496-1922
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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 | 002398
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License Number State | CT
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