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General NPI Number Information
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NPI Number | 1972647360
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Entity Type | Organization
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Legal Business Name | ROGER HIRONS OD LLC
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 KANE ST
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City | WEST HARTFORD
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State | CT
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Zip | 06119-2109
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Country | US
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Telephone | 860-233-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HORIZON LN
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City | GLASTONBURY
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State | CT
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Zip | 06033-2829
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Country | US
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Telephone | 860-633-8114
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER HIRONS
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Credential | OD
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Telephone | 860-633-8114
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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 | 001086
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License Number State | CT
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