Doctor Name: | MRS. ELIZABETH BERGERON |
NPI Number: | 1225486616 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.O. |
License Number: | 001544 |
Business Practice Address: | 235 Queen St Southington, CT - 064891915 |
Business Phone Number: | 8606212310 |
Business Fax Number: | 8606212336 |
Mailing Address: | 235 Queen St, SOUTHINGTON |
State: | CT |
Postal Code: | 064891915 |
Phone Number: | 8606212310 |
Fax Number: | 8606212336 |
NPI Enumeration Date: | 05/26/2016 |
NPI Last Update Date: | 05/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 001544 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |