Individual
MR. EDWARD M VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LO
Contact information
Practice address
656 NEW HAVEN AVE, DERBY, CT 06418-2528
(203) 736-2675
Mailing address
656 NEW HAVEN AVE, DERBY, CT 06418-2528
(203) 736-2675
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004086949
—
CT
Enumeration date
08/20/2006
Last updated
03/04/2016
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