Provider Demographics
NPI:1235940990
Name:TURBERT, PATRICIA (LO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TURBERT
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 1:96 FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1643
Mailing Address - Country:US
Mailing Address - Phone:860-928-6321
Mailing Address - Fax:
Practice Address - Street 1:96 FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1643
Practice Address - Country:US
Practice Address - Phone:860-928-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001714156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician