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General NPI Number Information
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NPI Number | 1316321565
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Entity Type | Individual
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Provider Name | RUSSELL FRITZ JR. LO
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 2313 WHITNEY AVE. SUITE 1D
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City | HAMDEN
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State | CT
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Zip | 06518-3504
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Country | US
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Telephone | 203-248-8224
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Fax | 203-248-8628
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Provider Business Mailing Address
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Address Line | 2313 WHITNEY AVE. SUITE 1D
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City | HAMDEN
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State | CT
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Zip | 06518-3504
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Country | US
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Telephone | 203-248-8224
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Fax | 203-248-8628
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 000687
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License Number State | CT
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