Healthcare Provider Details

I. General information

NPI: 1710946793
Provider Name (Legal Business Name): DONNA TROTTA LINSLEY OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MAIN ST
STRATFORD CT
06614-4945
US

IV. Provider business mailing address

3060 MAIN ST
STRATFORD CT
06614-4945
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-3166
  • Fax: 203-377-4337
Mailing address:
  • Phone: 203-378-3166
  • Fax: 203-377-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1245
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: