Provider Demographics
NPI:1134130867
Name:LUCEY, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:LUCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 KING ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-6052
Mailing Address - Country:US
Mailing Address - Phone:860-749-6485
Mailing Address - Fax:860-749-1562
Practice Address - Street 1:1699 KING ST STE 102
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-6052
Practice Address - Country:US
Practice Address - Phone:860-749-6485
Practice Address - Fax:860-749-1562
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032769207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001327693Medicaid
CT001327693Medicaid
E16804Medicare UPIN