=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609003789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSAMARIA PICCOLO ROBISON L.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2009
-----------------------------------------------------
Last Update Date | 06/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 844 N COLONY RD
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06492-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-265-5627
-----------------------------------------------------
Fax | 203-269-7712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 COLLINDALE DR
-----------------------------------------------------
City | MERIDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06450-8319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-631-8660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | LO1290
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------