Healthcare Provider Details

I. General information

NPI: 1295645190
Provider Name (Legal Business Name): ERIK LACHENDRO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GREEN HOLLOW RD
DANIELSON CT
06239-3509
US

IV. Provider business mailing address

13 GANNY TER
ENFIELD CT
06082-3005
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-1588
  • Fax:
Mailing address:
  • Phone: 860-779-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3495
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: