Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 003201 | CT |
NPI | 1013589290 |
---|---|
Provider Name | Mrs. Grace Kehoe |
First Address | Farmington, CT 06032-2633 |
Second Address | Farmington, CT 06032-2633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2021 |
Last Update Date | 15/07/2021 |