MEDICARE: MADELIN SANTOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1472	CT

General Provider Information

NPI Number	:	1366209041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELIN SANTOS

Provider Business Mailing Address
First Line	:	295 PARKER AVE
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06450-5928
Country	:	US
Telephone Number	:	203-685-7211
Fax Number	:

Provider Business Practice Location Address
First Line	:	844 N COLONY RD
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2771
Country	:	US
Telephone Number	:	203-265-5627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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Directions to “ MADELIN SANTOS ” Practice Location

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