Healthcare Provider Details

I. General information

NPI: 1225532765
Provider Name (Legal Business Name): CAROLYNE RIEHLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 01/16/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8031
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8031
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-7687
  • Fax: 860-679-0131
Mailing address:
  • Phone: 860-679-7687
  • Fax: 860-679-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12695693-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number12695693-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number075732
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: