MEDICARE: CHARLENE SIROIS

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	156FX1800X	Optician	1057	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CT. 1057	OTHER	CT	STATE LICENSE

General Provider Information

NPI Number	:	1649628793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE SIROIS

Provider Business Mailing Address
First Line	:	474 BOSTON POST RD
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1052
Country	:	US
Telephone Number	:	860-423-5230
Fax Number	:	860-423-5267

Provider Business Practice Location Address
First Line	:	474 BOSTON POST RD
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1052
Country	:	US
Telephone Number	:	860-423-5230
Fax Number	:	860-423-5267

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “ CHARLENE SIROIS ” Practice Location

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