Healthcare Provider Details

I. General information

NPI: 1255446134
Provider Name (Legal Business Name): SARAH J RIVARD LO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 HIGHLAND AV
CHESHIRE CT
06410
US

IV. Provider business mailing address

546 SO BROAD ST
MERIDEN CT
06450
US

V. Phone/Fax

Practice location:
  • Phone: 203-271-3937
  • Fax: 203-271-3937
Mailing address:
  • Phone: 203-235-2511
  • Fax: 203-639-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: