Individual
TIMOTHY A FAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
450 PROVIDENCE RD, BROOKLYN, CT 06234-1823
(860) 412-5141
(860) 774-1656
Mailing address
450 PROVIDENCE RD, BROOKLYN, CT 06234-1823
(860) 412-5141
(860) 774-1656
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1629
CT
156FX1800X
Optician
6151
MA
156FX1800X
Optician
OP0035
RI
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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