| NPI | 1659695344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE ROBERT BERTOLLI Member 203-238-3080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 2015) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2010-11-24 |