Provider Demographics
NPI:1497815419
Name:ARMSTRONG, KELLI ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:ANN
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-783-9632
Mailing Address - Fax:203-874-7435
Practice Address - Street 1:50 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-783-9632
Practice Address - Fax:203-874-7435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00273957OtherRAILROAD MEDICARE
CT410000890Medicare PIN
T22779Medicare UPIN
P00273957OtherRAILROAD MEDICARE
CT1284050001Medicare NSC