Healthcare Provider Details

I. General information

NPI: 1689868291
Provider Name (Legal Business Name): LAUREN BRIANA GUZIK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WELLES ST
GLASTONBURY CT
06033-2047
US

IV. Provider business mailing address

33 WELLES ST
GLASTONBURY CT
06033-2047
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-1401
  • Fax: 860-633-1401
Mailing address:
  • Phone: 860-633-1401
  • Fax: 860-432-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2701
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: