Provider Demographics
NPI:1508038605
Name:DR. GEMMA S. STIRBA, LLC
Entity Type:Organization
Organization Name:DR. GEMMA S. STIRBA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:SOLIMAN
Authorized Official - Last Name:STIRBA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-449-0185
Mailing Address - Street 1:33 BAXTER RD
Mailing Address - Street 2:UNIT 2C
Mailing Address - City:WILLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06279-1805
Mailing Address - Country:US
Mailing Address - Phone:860-449-0185
Mailing Address - Fax:869-449-0421
Practice Address - Street 1:150 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3442
Practice Address - Country:US
Practice Address - Phone:860-449-0185
Practice Address - Fax:860-449-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty