Provider Demographics
NPI:1730564881
Name:STE. MARIE OPTICIANS INC
Entity type:Organization
Organization Name:STE. MARIE OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-289-5555
Mailing Address - Street 1:386 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-289-5555
Mailing Address - Fax:860-528-6402
Practice Address - Street 1:386 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-289-5555
Practice Address - Fax:860-528-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT431332H00000X
CT1045332H00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004036562Medicaid