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Individual

DIANA NGO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
2600 POST RD STE 210, SOUTHPORT, CT 06890-3206
(203) 255-4005
Mailing address
2600 POST RD STE 210, SOUTHPORT, CT 06890-3206
(203) 255-4005

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3223
CT
152WV0400X
Vision Therapy Optometrist
3223
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3223
CONNECTICUT LICENSE
CT
Enumeration date
05/09/2022
Last updated
05/09/2022
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