Healthcare Provider Details

I. General information

NPI: 1558286278
Provider Name (Legal Business Name): KATIE LINDBERG LO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 EAST ST
PLAINVILLE CT
06062-2309
US

IV. Provider business mailing address

28 EAST ST
PLAINVILLE CT
06062-2309
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-9378
  • Fax: 860-793-2494
Mailing address:
  • Phone: 860-793-9378
  • Fax: 860-793-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number38.001975
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: