Provider Demographics
NPI:1942616636
Name:MOJICA, EMILIE (OD)
Entity Type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:
Last Name:MOJICA
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 1:499 FARMINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1943
Mailing Address - Country:US
Mailing Address - Phone:860-678-0202
Mailing Address - Fax:860-678-0224
Practice Address - Street 1:499 FARMINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1943
Practice Address - Country:US
Practice Address - Phone:860-678-0202
Practice Address - Fax:860-678-0224
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist