Organization
CHARLES BONELLI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHY B PEET (OFFICE MANAGER)
(860) 693-2289
Entity
Organization
Contact information
Practice address
220 ALBANY TPKE, CANTON, CT 06019-2520
(860) 693-2289
(860) 693-1835
Mailing address
220 ALBANY TPKE, PO BOX 14, CANTON, CT 06019-2520
(860) 693-2289
(860) 693-1835
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
763
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004024170
—
CT
Enumeration date
01/31/2008
Last updated
05/20/2013
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