Provider Demographics
NPI:1942596317
Name:DYKAS, ROSE-MARY JANE (LO)
Entity Type:Individual
Prefix:MISS
First Name:ROSE-MARY
Middle Name:JANE
Last Name:DYKAS
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 1:161 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1021
Mailing Address - Country:US
Mailing Address - Phone:860-519-6228
Mailing Address - Fax:
Practice Address - Street 1:161 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1021
Practice Address - Country:US
Practice Address - Phone:860-519-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001658156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician