Provider Demographics
NPI:1518221142
Name:MITCHELL, CAITLYN KENNEDY (OD)
Entity Type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:KENNEDY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAITLYN
Other - Middle Name:ASHLEY
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:69 BUCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-2702
Mailing Address - Country:US
Mailing Address - Phone:845-216-1195
Mailing Address - Fax:
Practice Address - Street 1:87 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2514
Practice Address - Country:US
Practice Address - Phone:203-574-2020
Practice Address - Fax:203-465-1481
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007835-1152WC0802X
CT3251152W00000X
NYTUV007835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management