Provider Demographics
NPI:1134230618
Name:RAFALOWSKY, STEVEN (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:RAFALOWSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SANER RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1409
Mailing Address - Country:US
Mailing Address - Phone:860-295-8306
Mailing Address - Fax:860-295-9258
Practice Address - Street 1:6 SANER RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1409
Practice Address - Country:US
Practice Address - Phone:860-295-8306
Practice Address - Fax:860-295-9258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist