Healthcare Provider Details

I. General information

NPI: 1689508475
Provider Name (Legal Business Name): LILY BLANCHETTE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MIDDLETOWN RD
COLCHESTER CT
06415-2236
US

IV. Provider business mailing address

715 MIDDLETOWN RD
COLCHESTER CT
06415-2236
US

V. Phone/Fax

Practice location:
  • Phone: 860-531-3852
  • Fax:
Mailing address:
  • Phone: 860-531-3852
  • Fax: 860-468-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: