Provider Demographics
NPI:1003574773
Name:MAZZAFERRO, HEATHER HALL (LO)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:HALL
Last Name:MAZZAFERRO
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COOK ST APT 7
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1439
Mailing Address - Country:US
Mailing Address - Phone:860-459-6202
Mailing Address - Fax:
Practice Address - Street 1:333 KENNEDY DR STE L202
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-7201
Practice Address - Country:US
Practice Address - Phone:860-482-9399
Practice Address - Fax:860-482-0477
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter