Provider Demographics
NPI:1871585794
Name:CID, NOELBIS (OD)
Entity type:Individual
Prefix:DR
First Name:NOELBIS
Middle Name:
Last Name:CID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4107
Mailing Address - Country:US
Mailing Address - Phone:203-366-8099
Mailing Address - Fax:
Practice Address - Street 1:1090 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4107
Practice Address - Country:US
Practice Address - Phone:203-366-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22310Medicare UPIN
CT410000422Medicare PIN
CT0234420001Medicare NSC