Healthcare Provider Details

I. General information

NPI: 1841322633
Provider Name (Legal Business Name): COHENS FASHION OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARTFORD TNPK
WATERFORD CT
06385
US

IV. Provider business mailing address

850 HARTFORD TNPK
WATERFORD CT
06385
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-7360
  • Fax: 860-444-1800
Mailing address:
  • Phone: 860-444-7360
  • Fax: 860-444-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1317
License Number StateCT

VIII. Authorized Official

Name: MR. KIRK A LARSEN
Title or Position: DIRECTOR OF OPERATIONS OPTICIAN
Credential: LO OPTICIAN
Phone: 860-444-7360