Organization
KIM E NEELY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA O'BRIEN L.O. (LICENSED OPTICIAN)
(860) 928-6321
Entity
Organization
Contact information
Practice address
5 KENNEDY DR, PUTNAM, CT 06260-1939
(860) 928-6321
Mailing address
5 KENNEDY DR, PUTNAM, CT 06260-1939
(860) 928-6321
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
000812
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004167492
—
CT
Enumeration date
01/22/2008
Last updated
09/08/2008
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