Organization
LAKEVILLE EYE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM MARTIN KIRBER M.D. (MANAGING MEMBER)
86043350072
Entity
Organization
Contact information
Practice address
31 PORTER ST, LAKEVILLE, CT 06039-1214
(860) 435-0072
(860) 435-9831
Mailing address
31 PORTER ST, PO BOX 548, LAKEVILLE, CT 06039-1214
(860) 435-0072
(860) 435-9831
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
023349
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D100000086
MEDICARE PTAN
—
Enumeration date
07/29/2008
Last updated
03/03/2009
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