Healthcare Provider Details

I. General information

NPI: 1093648628
Provider Name (Legal Business Name): TANGLER JOELEEN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GOLD STAR HWY
GROTON CT
06340-3442
US

IV. Provider business mailing address

150 GOLD STAR HWY
GROTON CT
06340-3442
US

V. Phone/Fax

Practice location:
  • Phone: 860-449-0185
  • Fax: 860-449-0421
Mailing address:
  • Phone: 860-449-0185
  • Fax: 860-449-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1514
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: