Provider Demographics
NPI:1306075882
Name:COLLIER, JUANITA D (MS, OD)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:D
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MS, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 B SHUNPIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1143
Mailing Address - Country:US
Mailing Address - Phone:860-632-8243
Mailing Address - Fax:866-600-2323
Practice Address - Street 1:181 B SHUNPIKE ROAD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1143
Practice Address - Country:US
Practice Address - Phone:860-632-8243
Practice Address - Fax:866-600-2323
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002779152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy