Individual
KIMBERLY GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LO
Contact information
Practice address
505 WILLARD AVE STE 2B, NEWINGTON, CT 06111-2650
(860) 667-0207
Mailing address
59 BUCKLAND RD, WETHERSFIELD, CT 06109-1204
(203) 887-1932
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1694
CT
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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