Organization
FEDORA OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J. FEDORA L.O. (PRESIDENT)
(860) 646-3577
Entity
Organization
Contact information
Practice address
236 N MAIN ST, MANCHESTER, CT 06042-2004
(860) 646-3577
(860) 643-9733
Mailing address
236 N MAIN ST, MANCHESTER, CT 06042-2004
(860) 646-3577
(860) 643-9733
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
001359
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750507380CT
ANTHEM BLUE COSS BLUE SHIELD
CT
01
—
CU6991
ACH HEALTH NET
CT
Enumeration date
04/18/2007
Last updated
02/18/2021
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