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General NPI Number Information
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NPI Number | 1376681510
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Entity Type | Organization
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Legal Business Name | SUSAN J. DEVINE OD, LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 44 PROSPECT HILL RD
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City | EAST WINDSOR
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State | CT
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Zip | 06088-9501
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Country | US
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Telephone | 860-623-8013
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Fax | 860-627-6433
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | EAST WINDSOR
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State | CT
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Zip | 06088-0438
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Country | US
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Telephone | 860-623-8013
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Fax | 860-627-6433
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN J DEVINE
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Credential | OD
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Telephone | 860-623-8013
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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 |
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License Number State |
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