Provider Demographics
NPI:1679629679
Name:SIERRA, ANGEL (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:
Last Name:SIERRA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2524
Mailing Address - Country:US
Mailing Address - Phone:860-728-5200
Mailing Address - Fax:860-828-5203
Practice Address - Street 1:86 PARK ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2524
Practice Address - Country:US
Practice Address - Phone:860-728-5200
Practice Address - Fax:860-828-5203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1098156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician