Individual
ELIZABETH FAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
155 WATERFORD PARKWAY N., WATERFORD, CT 06385
(860) 437-3748
Mailing address
51 HI TOP HILL RD, VOLUNTOWN, CT 06384-1813
(860) 376-8934
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
001497
CT
Other
Enumeration date
06/30/2009
Last updated
06/30/2009
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