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Individual

RICHARD J COLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
162 MOUNTAIN ROAD, SUFFIELD, CT 06078
(860) 668-5556
(860) 668-5556
Mailing address
162 MOUNTAIN ROAD, SUFFIELD, CT 06078
(860) 668-0266
(860) 668-5556

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
000736
CT
152WC0802X
Corneal and Contact Management Optometrist
000736
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000736
ST OF CT LICENSE NUMBER
CT
05
004023933
CT
01
060873489
TAX ID
CT
Enumeration date
10/16/2006
Last updated
07/10/2008
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