Provider Demographics
NPI:1477511426
Name:LEMIRE, KEITH M (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:LEMIRE
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 1:741 BROAD ST EXT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-442-5663
Mailing Address - Fax:860-444-7778
Practice Address - Street 1:741 BROAD ST EXT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-442-5663
Practice Address - Fax:860-444-7778
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002391207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410045811OtherRR MEDICARE
U62318Medicare UPIN
CT410000986Medicare PIN