Provider Demographics
NPI:1881228237
Name:RIVARD, RENE R (LO, FCLSA(H))
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:R
Last Name:RIVARD
Suffix:
Gender:M
Credentials:LO, FCLSA(H)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 PARK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3443
Mailing Address - Country:US
Mailing Address - Phone:860-521-9230
Mailing Address - Fax:860-521-1709
Practice Address - Street 1:639 PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3443
Practice Address - Country:US
Practice Address - Phone:860-521-9230
Practice Address - Fax:860-521-1709
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician