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General NPI Number Information
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NPI Number | 1730340290
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Entity Type | Organization
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Legal Business Name | HARLEY W HENION OPTICIAN INC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 501 FROST RD
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-757-7606
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Fax | 203-757-1781
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Provider Business Mailing Address
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Address Line | 501 FROST RD
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-757-7606
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Fax | 203-757-1781
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN W HENION
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Credential | LO
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Telephone | 203-757-7606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | L01041
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License Number State | CT
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