Healthcare Provider Details

I. General information

NPI: 1700445632
Provider Name (Legal Business Name): PRISCILLA KUO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N COLONY RD
WALLINGFORD CT
06492-2771
US

IV. Provider business mailing address

732 KYLE LN
WEST HAVEN CT
06516-7925
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-6698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3104
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: