Fedora Optical Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

License

001359 Issued in CT

Legal business name

FEDORA OPTICAL INC

Practice address

236 N Main St
Manchester, CT 06042-2004

Phone

(860) 646-3577

Fax

(860) 643-9733

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Peter J. Fedora, L.O.

Title

President

Phone

(860) 646-3577

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1750507380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422004",
            "telephone_number": "860-646-3577",
            "fax_number": "860-643-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422004",
            "telephone_number": "860-646-3577",
            "fax_number": "860-643-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FEDORA OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "FEDORA",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-646-3577",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.O."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "CT",
            "license": "001359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE COSS BLUE SHIELD",
            "identifier": "1750507380CT",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACH HEALTH NET",
            "identifier": "CU6991",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Farmer
• Alana J Farnsworth
• Jennifer Farrell
• Craig Thomas Fasullo, ND
• Tera Fazzino
• Peter John Fedora, L.O.
• Sarah Fedorchuck, LCSW
• Shannon C. Feeley
• Joann Ellen Feeney, RN BSN
• Carmen Delia Feliciano

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.