Provider Demographics
NPI:1871214544
Name:GROCHOWSKI, TERESA (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:GROCHOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4263
Mailing Address - Country:US
Mailing Address - Phone:860-443-3250
Mailing Address - Fax:
Practice Address - Street 1:914 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4263
Practice Address - Country:US
Practice Address - Phone:860-443-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009668152W00000X
FLOPC6197152W00000X
MAOPT5677152W00000X
RIODTG00744152W00000X
CT3373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC6197OtherFL OPTOMETRY LICENSE
RIODTG00744OtherRI OPTOMETRY LICENSE
NY009668OtherNYS OPTOMETRY LICENSE