Provider Demographics
NPI:1467054593
Name:DOYLE, CORIE BROWN (LO)
Entity Type:Individual
Prefix:MS
First Name:CORIE
Middle Name:BROWN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUNSHINE RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06375-1435
Mailing Address - Country:US
Mailing Address - Phone:860-908-7330
Mailing Address - Fax:
Practice Address - Street 1:79 WAWECUS ST STE 105
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2173
Practice Address - Country:US
Practice Address - Phone:860-889-3521
Practice Address - Fax:860-889-5999
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001715156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician