Provider Demographics
NPI:1770986366
Name:COLLETTE, LILY (OD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:480 W CENTRAL ST.
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:508-528-2040
Mailing Address - Fax:508-528-8644
Practice Address - Street 1:480 W CENTRAL ST.
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:508-528-2040
Practice Address - Fax:508-528-8644
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist