Provider Demographics
NPI:1508615758
Name:MULLIGAN, DOROTHY ROSE (OD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:ROSE
Last Name:MULLIGAN
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 1:22 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4240
Mailing Address - Country:US
Mailing Address - Phone:860-539-2828
Mailing Address - Fax:
Practice Address - Street 1:1013 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2181
Practice Address - Country:US
Practice Address - Phone:860-233-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3.003347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty