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General NPI Number Information
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NPI Number | 1356512719
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Entity Type | Organization
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Legal Business Name | MARSHALL OPTICAL
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 881 NEW HARWINTON ROAD
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City | TORRINGTON
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State | CT
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Zip | 06790-7208
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Country | US
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Telephone | 860-489-8999
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Fax | 860-626-8117
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Provider Business Mailing Address
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Address Line | 881 NEW HARWINTON ROAD
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City | TORRINGTON
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State | CT
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Zip | 06790-7208
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Country | US
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Telephone | 860-489-8999
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Fax | 860-626-8117
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLIFFORD WILLIAM MARSHALL
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Credential | LO LICENSED OPTICIAN
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Telephone | 860-489-8999
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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 | 00626
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License Number State | CT
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