Healthcare Provider Details

I. General information

NPI: 1487604617
Provider Name (Legal Business Name): THUYLINH N ROSCHANGAR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST STE 415
DANBURY CT
06810-5629
US

IV. Provider business mailing address

87 GRANDVIEW AVE
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-0117
  • Fax: 203-798-7048
Mailing address:
  • Phone: 203-574-2020
  • Fax: 203-596-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002681
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: