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General NPI Number Information
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NPI Number | 1487788634
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Entity Type | Organization
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Legal Business Name | PLAINVILLE OPTICAL
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 28 EAST ST
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City | PLAINVILLE
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State | CT
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Zip | 06062-2309
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Country | US
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Telephone | 860-793-9378
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Fax | 860-793-2494
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Provider Business Mailing Address
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Address Line | 28 EAST ST
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City | PLAINVILLE
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State | CT
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Zip | 06062-2309
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Country | US
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Telephone | 860-793-9378
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Fax | 860-793-2494
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Authorized Official
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Title or Position | OWNER & LICENSED OPTICIAN
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Name | JONATHAN LINDBERG
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Credential |
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Telephone | 860-793-9378
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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 | 001471
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | CT1106
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License Number State | CT
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