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General NPI Number Information
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NPI Number | 1063754406
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Entity Type | Individual
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Provider Name | JANELLE C FERN OD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 262 BROCKETT ST
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City | NEWINGTON
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State | CT
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Zip | 06111-3907
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Country | US
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Telephone | 860-667-2020
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Fax | 860-667-0770
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Provider Business Mailing Address
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Address Line | 262 BROCKETT ST
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City | NEWINGTON
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State | CT
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Zip | 06111-3907
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Country | US
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Telephone | 860-667-2020
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Fax | 860-667-0770
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2888
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License Number State | CT
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