Sidet Sou, OD, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

CT002732 Issued in CT

Legal business name

SIDET SOU, OD, LLC

Practice address

69 Pavilion Dr
Manchester, CT 06042-8702

Phone

(860) 644-9439

NPI assigned

Jun 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sidet Sou, O.D.

Title

Optometrist

Phone

(860) 644-9439

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1336301597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 PAVILION DR",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060428702",
            "telephone_number": "860-644-9439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 PAVILION DR",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060428702",
            "telephone_number": "860-644-9439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDET SOU, OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "SOU",
        "authorized_official_first_name": "SIDET",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "860-644-9439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "CT002732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard M Shoup, MD
• Whitney Showman-Boyer, PA-C
• Lina Shroof, M.D.
• Frederick Shuler, MD
• Wen Priscella Si
• Roohan Sidhu, D.D.S
• Karin L Sidman-Croghan, LPC
• Jahnna R Sieckowski
• Alexis Siegel, PA-C
• Diane Sieh

• Optometrist in Manchester, CT
• Providers in Manchester, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.