Provider Demographics
NPI:1932266558
Name:DUBIEL, ROBERT S (LO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:DUBIEL
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 1:386 BURNSIDE AVE.
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-289-5555
Mailing Address - Fax:860-528-6402
Practice Address - Street 1:386 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-289-5555
Practice Address - Fax:860-528-6402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT431156FX1800X
CTL0431332H00000X
CT1045332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier