Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001608 | CT |
NPI | 1053711226 |
---|---|
Provider Name | Kimberly A Lajoie-Ray |
First Address | Windsor, CT 06095-3635 |
Second Address | West Hartford, CT 06107-2133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 25/08/2014 |