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Individual

KENNETH L BURKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
175 MAIN ST S, WOODBURY, CT 06798-3405
(203) 263-3391
(203) 263-3390
Mailing address
PO BOX 384, WOODBURY, CT 06798-0384
(203) 263-3391
(203) 263-3390

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
000817
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
009287
BLOCK
CT
01
090000817CT01
ANTHEM
CT
01
0V0992
HEALTHNET
CT
01
3582
DAVIS VISION
CT
01
658049
CONNECTICARE
CT
01
83587
AETNA
CT
01
P382850
OXFORD
CT
Enumeration date
07/28/2006
Last updated
03/26/2008
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