Provider Demographics
NPI:1336802875
Name:ALBERTO, LAURA (LO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ALBERTO
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BLUEBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2503
Mailing Address - Country:US
Mailing Address - Phone:860-268-3302
Mailing Address - Fax:
Practice Address - Street 1:46 BLUEBERRY CIR
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2503
Practice Address - Country:US
Practice Address - Phone:860-268-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1697156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty