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General NPI Number Information
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NPI Number | 1801313606
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Entity Type | Individual
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Provider Name | KORAB SPAHIU OD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 495 UNION ST STE 1082
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City | WATERBURY
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State | CT
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Zip | 06706-1285
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Country | US
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Telephone | 203-591-8353
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Fax | 203-591-1713
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Provider Business Mailing Address
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Address Line | 671 MERIDEN RD
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City | WATERBURY
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State | CT
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Zip | 06705-2432
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Country | US
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Telephone |
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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 | 3018
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License Number State | CT
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