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General NPI Number Information
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NPI Number | 1346900412
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Entity Type | Organization
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Legal Business Name | WILD APPLE EYE III LLC
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 34 MAIN ST
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City | HEBRON
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State | CT
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Zip | 06248-1515
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Country | US
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Telephone | 860-228-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 34 MAIN ST
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City | HEBRON
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State | CT
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Zip | 06248-1515
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Country | US
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Telephone | 860-228-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS PARADIS
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Credential | OD
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Telephone | 860-391-3366
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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 |
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License Number State |
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