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General NPI Number Information
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NPI Number | 1295869832
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Entity Type | Individual
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Provider Name | MARY W. FEDUS O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 475 HARTFORD RD
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City | NEW BRITAIN
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State | CT
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Zip | 06053-1524
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Country | US
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Telephone | 860-826-1052
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Fax | 860-826-7047
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Provider Business Mailing Address
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Address Line | 475 HARTFORD RD
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City | NEW BRITAIN
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State | CT
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Zip | 06053-1524
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Country | US
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Telephone | 860-826-1052
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Fax | 860-826-7047
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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 | 00#1003
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License Number State | CT
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