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NPI Code Detail

MEDICARE: MATTHEW BIGOS L.O.

MEDICARE: MATTHEW BIGOS L.O.
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
1156FX1800XOptician1646CT

General Provider Information

NPI Number : 1477913515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW BIGOS L.O.
Provider Business Mailing Address
First Line : 420 BUCKLAND HILLS DR
Second Line :
City : MANCHESTER
State : CT
Zip : 06042-8755
Country : US
Telephone Number : 860-644-1203
Fax Number : 860-644-2936
Provider Business Practice Location Address
First Line : 420 BUCKLAND HILLS DR
Second Line :
City : MANCHESTER
State : CT
Zip : 06042-8755
Country : US
Telephone Number : 860-644-1203
Fax Number : 860-644-2936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2016
Last Update Date : 03/02/2016

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