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General NPI Number Information
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NPI Number | 1932294287
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Entity Type | Individual
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Provider Name | ANDREW H LY OD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1060 NEW HAVEN RD
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City | NAUGATUCK
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State | CT
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Zip | 06770-4731
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Country | US
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Telephone | 203-720-2395
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Fax | 203-723-7849
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Provider Business Mailing Address
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Address Line | 401 THE MEWS
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City | ROCKY HILL
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State | CT
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Zip | 06067-3254
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Country | US
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Telephone | 203-720-2395
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Fax | 203-723-7849
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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 | CT002624
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License Number State | CT
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