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General NPI Number Information
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NPI Number | 1760969133
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE DELEON OD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 58 MAPLE ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-4160
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Country | US
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Telephone | 203-729-2226
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Fax | 203-729-2227
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Provider Business Mailing Address
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Address Line | 8 MORELAND AVE
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City | WATERBURY
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State | CT
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Zip | 06705-2924
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Country | US
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Telephone | 203-510-7339
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3096
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T008848
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License Number State | NY
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