Healthcare Provider Details

I. General information

NPI: 1053341701
Provider Name (Legal Business Name): TRACEY LYNN ASMUS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY LYNN ASMUS LOMBARDI OD

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 BERLIN TPKE
NEWINGTON CT
06111-4114
US

IV. Provider business mailing address

27 FOXTAIL RD
MIDDLETOWN CT
06457-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-594-4585
  • Fax: 860-667-4377
Mailing address:
  • Phone: 860-632-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002561
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: