Provider Demographics
NPI:1801498589
Name:MARREN, NANCY J (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:MARREN
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 FARMINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2356
Mailing Address - Country:US
Mailing Address - Phone:860-837-9676
Mailing Address - Fax:860-837-9601
Practice Address - Street 1:599 FARMINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2356
Practice Address - Country:US
Practice Address - Phone:860-837-9676
Practice Address - Fax:860-837-9601
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001357156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician