Provider Demographics
NPI:1316003775
Name:FEDYNA, LORRAINE J (OD)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:J
Last Name:FEDYNA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1322
Mailing Address - Country:US
Mailing Address - Phone:203-518-1014
Mailing Address - Fax:860-417-2255
Practice Address - Street 1:955 FERRY BLVD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-6094
Practice Address - Country:US
Practice Address - Phone:203-375-7988
Practice Address - Fax:203-375-7989
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02818Medicare PIN