Provider Demographics
NPI:1043794167
Name:ISABELLE, COLLEEN M (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:ISABELLE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1487
Mailing Address - Country:US
Mailing Address - Phone:413-586-8400
Mailing Address - Fax:866-644-0872
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1487
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:866-644-0872
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5060156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician