Individual provider · NPI-1

Mark Calixte, OD

Optometrist · Cromwell, CT

NPI number1407460033
StatusActive
Last updated in NPPESSep 1, 2020

Details

NPI
1407460033
Entity type
Individual (NPI-1)
Name
Mark Calixte
Credential
OD
Sex
Male
Sole proprietor
No
Enumeration date
Sep 1, 2020
Certification date
Aug 31, 2020
Last updated
Sep 1, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist3167CTYes

Practice location

161 Berlin Rd
Cromwell, CT 06416-1059

Phone 860-635-6221

Mailing address

117 Silver St
Agawam, MA 01001-2457

Phone 772-267-7635

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