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General NPI Number Information
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NPI Number | 1588279590
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Entity Type | Organization
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Legal Business Name | EYES ON NIGRELLI, LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 18 PENNSYLVANIA AVE
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City | NIANTIC
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State | CT
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Zip | 06357-3231
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Country | US
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Telephone | 860-691-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 531 TAUGWONK RD
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City | STONINGTON
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State | CT
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Zip | 06378-1805
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Country | US
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Telephone | 860-552-9669
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MARIA ALEXA PARADIS
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Credential | OD
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Telephone | 860-691-0101
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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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