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General NPI Number Information
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NPI Number | 1477097285
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Entity Type | Organization
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Legal Business Name | OEC WATERBURY LLC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 3528 E MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705-3873
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Country | US
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Telephone | 203-377-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 7365 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-1300
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Country | US
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Telephone | 203-377-3937
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Fax | 888-741-0620
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KAREN BONNANZIO
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Credential | O.D.
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Telephone | 203-377-3937
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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 | 002346
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License Number State | CT
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