Provider Demographics
NPI:1396270211
Name:CITRON, CORIE
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:CITRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3442
Mailing Address - Country:US
Mailing Address - Phone:860-449-0185
Mailing Address - Fax:860-449-0421
Practice Address - Street 1:150 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3442
Practice Address - Country:US
Practice Address - Phone:860-449-0185
Practice Address - Fax:860-449-0421
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1668156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician