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General NPI Number Information
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NPI Number | 1548317027
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Entity Type | Organization
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Legal Business Name | PATRICIA YOUNGQUIST OD, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 COMMERCIAL PKWY VISION CENTER
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City | BRANFORD
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State | CT
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Zip | 06405-2537
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Country | US
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Telephone | 203-483-1901
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Fax | 203-488-3560
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Provider Business Mailing Address
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Address Line | 186 LANSDOWNE LN
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City | CHESHIRE
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State | CT
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Zip | 06410-1584
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Country | US
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Telephone | 203-272-3342
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PATRICIA A YOUNGQUIST
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Credential | OD
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Telephone | 203-272-3342
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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 | 2200
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License Number State | CT
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