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General NPI Number Information
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NPI Number | 1962919605
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Entity Type | Individual
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Provider Name | KATHARINA ERNST-SIXTO LICENSED OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 495 HAWLEY LN
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City | STRATFORD
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State | CT
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Zip | 06614-1514
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Country | US
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Telephone | 203-375-5819
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Fax | 203-377-4337
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Provider Business Mailing Address
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Address Line | 495 HAWLEY LN
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City | STRATFORD
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State | CT
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Zip | 06614-1514
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Country | US
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Telephone | 203-375-5819
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Fax | 203-377-4337
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 001623
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 001623
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License Number State | CT
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