Provider Demographics
NPI:1013428754
Name:ANGELES-PURIAMAN, ALFREDO A (LO)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:A
Last Name:ANGELES-PURIAMAN
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 1:150 BARNUM AVENUE CUTOFF
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5111
Mailing Address - Country:US
Mailing Address - Phone:203-502-7637
Mailing Address - Fax:
Practice Address - Street 1:150 BARNUM AVENUE CUTOFF
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5111
Practice Address - Country:US
Practice Address - Phone:203-502-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1752156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty