Fung, Audrey S

Fung, Audrey S is an individual health care provider with primary practice located at 3600 E Main St , Waterbury CT 06705-3851. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Fung, Audrey S can be contacted via phone (203) 596-0406.

Contact Information

Primary practice address
3600 E Main St Waterbury CT 06705-3851
Fax: (203) 756-7316
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 002621 Connecticut

Profile Details

NPI number 1083615850
LBN Legal business name Fung, Audrey S
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2005
Last updated Jun 27th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083615850 NPPES
Connecticut MEDICAID 004249951

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