Healthcare Provider Details

I. General information

NPI: 1306075882
Provider Name (Legal Business Name): JUANITA D COLLIER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 09/03/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S. MAIN STREET SUITE 200
CHESHIRE CT
06410
US

IV. Provider business mailing address

680 S. MAIN STREET SUITE 200
CHESHIRE CT
06410
US

V. Phone/Fax

Practice location:
  • Phone: 860-632-8243
  • Fax: 860-407-9443
Mailing address:
  • Phone: 860-632-8243
  • Fax: 860-407-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002779
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number002779
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: