Provider Demographics
NPI:1396185021
Name:MARKOWSKI, ALLISE LAUREN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISE
Middle Name:LAUREN
Last Name:MARKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612B QUAKER LN S
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1027
Mailing Address - Country:US
Mailing Address - Phone:860-236-1218
Mailing Address - Fax:
Practice Address - Street 1:612B QUAKER LN S
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1027
Practice Address - Country:US
Practice Address - Phone:860-236-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist