Provider Demographics
NPI:1053160754
Name:CHARPENTIER, ROZALIA (LO)
Entity type:Individual
Prefix:
First Name:ROZALIA
Middle Name:
Last Name:CHARPENTIER
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 1:40 BARR RD
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6918
Mailing Address - Country:US
Mailing Address - Phone:203-631-4101
Mailing Address - Fax:
Practice Address - Street 1:161 BERLIN RD.
Practice Address - Street 2:STE 700
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1048
Practice Address - Country:US
Practice Address - Phone:860-635-6221
Practice Address - Fax:860-632-9231
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1482156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty