John George Baldelli Jr., LICENSED OPTICIAN
Individual provider Active NPI Optician · Waterbury, CT
NPI 1194581801 · NPPES record last updated Feb 28, 2024
Key facts
- NPI
- 1194581801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 001738 (CT)
- Practice address
- 1201 West Main Street
Waterbury, CT 06708-3105 - Phone
- (203) 597-9100
- Fax
- (203) 597-1696
- NPI assigned
- Feb 21, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5969 | MA | MD | Mental Health Counselor |
| 001738 | CT | MD | Chiropractor |
| C005696-1 | NY | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | C005696-1 | NY | |
| Optician | 156FX1800X | 5969 | MA | |
| Optician | 156FX1800X | 001738 | CT | Yes |
Addresses
Primary practice location
1201 West Main Street
Waterbury, CT 06708-3105
Mailing address
1201 West Main Street
Waterbury, CT 06708-3105
Phone (203) 597-9100
Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.