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General NPI Number Information
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NPI Number | 1609392448
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Entity Type | Individual
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Provider Name | GLENN MARTIN FRYER
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 47 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4706
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Country | US
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Telephone | 860-674-8558
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Fax | 860-674-1265
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Provider Business Mailing Address
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Address Line | 47 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4706
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Country | US
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Telephone | 860-674-8558
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Fax | 860-674-1265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 000367
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License Number State | CT
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