Provider Demographics
NPI:1790894616
Name:ULC, STEVEN LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LOUIS
Last Name:ULC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:108 CHURCH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4143
Mailing Address - Country:US
Mailing Address - Phone:203-729-6178
Mailing Address - Fax:203-729-3465
Practice Address - Street 1:108 CHURCH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4143
Practice Address - Country:US
Practice Address - Phone:203-729-6178
Practice Address - Fax:203-729-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410001145Medicare ID - Type Unspecified
CTU60179Medicare UPIN