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Individual

DIANE MINTICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LO

Contact information

Practice address
58 CENTER ST, WALLINGFORD, CT 06492-4112
(203) 265-1541
(203) 265-3129
Mailing address
58 CENTER ST, WALLINGFORD, CT 06492-4112

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
001415
CT

Other

Enumeration date
05/03/2007
Last updated
07/08/2007
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