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General NPI Number Information
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NPI Number | 1275761918
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Entity Type | Organization
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Legal Business Name | GROVER OPTICIANS
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 2505 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06615-5839
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Country | US
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Telephone | 203-378-2281
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Fax | 203-377-0233
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Provider Business Mailing Address
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Address Line | 2505 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06615-5839
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Country | US
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Telephone | 203-378-2281
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Fax | 203-377-0233
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. BRIAN WILLIAM GROVER
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Credential | L.O.
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Telephone | 203-378-2281
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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 | 001123
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License Number State | CT
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