Provider Demographics
NPI:1710946793
Name:LINSLEY, DONNA TROTTA (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:TROTTA
Last Name:LINSLEY
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 1:3060 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4945
Mailing Address - Country:US
Mailing Address - Phone:203-378-3166
Mailing Address - Fax:203-377-4337
Practice Address - Street 1:3060 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4945
Practice Address - Country:US
Practice Address - Phone:203-378-3166
Practice Address - Fax:203-377-4337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1245156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5586240001Medicare ID - Type Unspecified