Provider Demographics
NPI:1386185239
Name:SALOIS, BENJAMIN (LO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SALOIS
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1728
Mailing Address - Country:US
Mailing Address - Phone:203-347-6257
Mailing Address - Fax:
Practice Address - Street 1:625 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2424
Practice Address - Country:US
Practice Address - Phone:860-630-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001744156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician