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General NPI Number Information
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NPI Number | 1467054593
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Entity Type | Individual
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Provider Name | CORIE BROWN DOYLE LO
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 79 WAWECUS ST STE 105
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City | NORWICH
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State | CT
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Zip | 06360-2173
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Country | US
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Telephone | 860-889-3521
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Fax | 860-889-5999
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Provider Business Mailing Address
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Address Line | 25 SUNSHINE RD
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City | QUAKER HILL
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State | CT
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Zip | 06375-1435
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Country | US
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Telephone | 860-908-7330
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 001715
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License Number State | CT
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