Individual
MR. LOUIS JOHN MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OCULARIST OCULAR PRO
Contact information
Practice address
204 N COLONY ST, WALLINGFORD, CT 06492-3656
(203) 284-3737
(203) 284-1300
Mailing address
204 N COLONY ST, WALLINGFORD, CT 06492-3656
(203) 284-3737
(203) 284-1300
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
0315275000
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004092201
—
CT
01
—
12DME0303CT01
ANTHEM BLUE CROSS AND BLU
CT
Enumeration date
03/22/2007
Last updated
07/08/2007
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