Provider Demographics
NPI:1821298613
Name:KIMBERLY ANN LUCEY M.D., P.C.
Entity Type:Organization
Organization Name:KIMBERLY ANN LUCEY M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-749-6485
Mailing Address - Street 1:1699 KING ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-6052
Mailing Address - Country:US
Mailing Address - Phone:860-749-6485
Mailing Address - Fax:860-749-1562
Practice Address - Street 1:1699 KING ST STE 102
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-6052
Practice Address - Country:US
Practice Address - Phone:860-749-6485
Practice Address - Fax:860-749-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032769CT207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02837OtherMEDICARE GROUP NUMBER