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General NPI Number Information
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NPI Number | 1619262516
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Entity Type | Individual
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Provider Name | DEBRA WILCOX L.O.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 120 COMMERCIAL PKWY
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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 | 203-483-1876
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Fax |
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Provider Business Mailing Address
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Address Line | 936 N FARMS RD
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City | WALLINGFORD
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State | CT
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Zip | 06492-1808
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Country | US
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Telephone | 860-395-7611
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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 | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number | 001653
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License Number State | CT
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