Individual
LISA ANN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1040 BARNUM AVE, STRATFORD, CT 06614-4968
(203) 378-2269
(203) 377-7207
Mailing address
1040 BARNUM AVE, STRATFORD, CT 06614-4968
(203) 378-2269
(203) 377-7207
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
999
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004161717
—
CT
Enumeration date
02/15/2007
Last updated
07/02/2010
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