Individual
MRS. SUSAN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
93 EVERGREEN WAY, SOUTH WINDSOR, CT 06074-6975
(860) 826-4460
(860) 826-4436
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002478
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004188847
—
CT
01
—
090002478CT04
BCBS & BCFP PROVIDER ID
CT
01
—
102478
CONNECTICARE
CT
01
—
1255448155
GHMC GROUP MEDICAID ID
CT
01
—
2V9149
HEALTH NET
CT
01
—
932470
BLOCK VISION
CT
01
—
CT2478
EYE MED VISION CARE
CT
Enumeration date
03/01/2007
Last updated
11/30/2022
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