Healthcare Provider Details

I. General information

NPI: 1750951224
Provider Name (Legal Business Name): HOLLY HEYSE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. HOLLY KNOECHEL

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GLASTONBURY BLVD STE 17
GLASTONBURY CT
06033-4405
US

IV. Provider business mailing address

33 BLUE HERON DR
EAST HAMPTON CT
06424-1368
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3205
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: