Organization
SIDET SOU, OD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIDET SOU O.D. (OPTOMETRIST)
(860) 644-9439
Entity
Organization
Contact information
Practice address
69 PAVILION DR, MANCHESTER, CT 06042-8702
(860) 644-9439
Mailing address
69 PAVILION DR, MANCHESTER, CT 06042-8702
(860) 644-9439
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CT002732
CT
Other
Enumeration date
06/30/2008
Last updated
09/06/2023
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