Provider Demographics
NPI:1861565426
Name:GHEORGHE-YOUSSEFI, MARIA LUIZA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA LUIZA
Middle Name:
Last Name:GHEORGHE-YOUSSEFI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LUIZA
Other - Middle Name:
Other - Last Name:YOUSSEFI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:658 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4336
Mailing Address - Country:US
Mailing Address - Phone:203-237-2020
Mailing Address - Fax:203-237-2040
Practice Address - Street 1:658 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4336
Practice Address - Country:US
Practice Address - Phone:203-237-2020
Practice Address - Fax:203-237-2040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist