# LAKEVILLE EYE ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952567026
- **Authorized official:** DR. WILLIAM MARTIN KIRBER M.D. (MANAGING MEMBER)
- **Authorized official phone:** 86043350072

## Contact information

- **Practice address:** 31 PORTER ST, LAKEVILLE, CT 06039-1214
- **Practice address phone:** (860) 435-0072
- **Practice address fax:** (860) 435-9831
- **Mailing address:** 31 PORTER ST, PO BOX 548, LAKEVILLE, CT 06039-1214
- **Mailing address phone:** (860) 435-0072
- **Mailing address fax:** (860) 435-9831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 023349 | CT | Yes |

## Other

- **Enumeration date:** 07/29/2008
- **Last updated:** 03/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | D100000086 | MEDICARE PTAN | — |