Individual
JENNIFER L CAPSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
83 QUARRY ST, WILLIMANTIC, CT 06226-1238
(860) 423-1619
(860) 423-7640
Mailing address
83 QUARRY ST, WILLIMANTIC, CT 06226-1238
(860) 423-1619
(860) 423-7640
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
27OA00646000
NJ
152W00000X
Optometrist
Primary
3067
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27OA00646000
STATE LICENSE
NJ
01
—
3067
STATE LICENSE
CT
01
—
CSP.0067484
STATE CONTROLLED SUBSTANCE LICENSE
CT
Enumeration date
11/15/2013
Last updated
03/06/2018
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