MEDICARE: THUYLINH N ROSCHANGAR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	002681	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487604617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUYLINH N ROSCHANGAR O.D.

Provider Business Mailing Address
First Line	:	87 GRANDVIEW AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-2514
Country	:	US
Telephone Number	:	203-574-2020
Fax Number	:	203-596-2230

Provider Business Practice Location Address
First Line	:	57 NORTH ST STE 415
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5629
Country	:	US
Telephone Number	:	203-794-0117
Fax Number	:	203-798-7048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/16/2022

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