Healthcare Provider Details

I. General information

NPI: 1447747928
Provider Name (Legal Business Name): KATHRYN BROGAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 BLACK ROCK TPKE
FAIRFIELD CT
06825-3229
US

IV. Provider business mailing address

2379 BLACK ROCK TPKE
FAIRFIELD CT
06825-3229
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-5590
  • Fax: 203-333-6722
Mailing address:
  • Phone: 203-333-5590
  • Fax: 203-333-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3074
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: