Individual
MRS. NOREEN DEDOMENICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
904 WHALLEY AVE, NEW HAVEN, CT 06515-1700
(203) 397-1928
Mailing address
58 STANLEY RD, HAMDEN, CT 06514-3238
(203) 288-0409
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LO702
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0521380001
MEDICARE
CT
01
—
100000702CT01
BLUE CROSS
CT
Enumeration date
04/12/2007
Last updated
12/18/2009
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