Individual
DR. FREDERICK ALLEN MOFFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
355 SALMON BROOK ST, GRANBY, CT 06035-1804
(860) 653-7440
Mailing address
20 COPPER HILL RD, GRANBY, CT 06035-1524
(860) 653-7440
(860) 653-7469
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2388
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004172699
—
CT
01
—
090002388CT 04
BLUE CROSS BLUE SHIELD
CT
Enumeration date
06/23/2006
Last updated
03/17/2022
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