Provider Demographics
NPI:1225048218
Name:KANE, ROBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:KANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 NEW MILFORD TPKE
Mailing Address - Street 2:PO BOX 2443
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777-1601
Mailing Address - Country:US
Mailing Address - Phone:860-868-2020
Mailing Address - Fax:860-868-2787
Practice Address - Street 1:168 NEW MILFORD TPKE
Practice Address - Street 2:
Practice Address - City:NEW PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06777-1601
Practice Address - Country:US
Practice Address - Phone:860-868-2020
Practice Address - Fax:860-868-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000767152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090000767CT02OtherBC/BS
CT090000767CT02OtherBC/BS