Provider Demographics
NPI:1659453959
Name:BERGERON-DUNCAN, KIM LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LEE
Last Name:BERGERON-DUNCAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:LEE
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:237 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2806
Mailing Address - Country:US
Mailing Address - Phone:860-489-4212
Mailing Address - Fax:
Practice Address - Street 1:110 HOPMEADOW ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9407
Practice Address - Country:US
Practice Address - Phone:860-658-1704
Practice Address - Fax:860-651-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT2596OtherEYEMED
CT090002596CT04OtherBLUE CROSS/BLUE SHIELD
CTCT2596OtherSUPERIOR VISION
CT2V5840OtherHEALTHNET
CT1811978OtherUNITED HEALTHCARE
CT259600OtherCONNECTICARE
CT5799268OtherCIGNA
CT9431179OtherPHCS
CT5799268OtherCIGNA