Provider Demographics
NPI:1205598786
Name:NEARINE, LUKE R
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:R
Last Name:NEARINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709A WINDHAM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06266-1129
Mailing Address - Country:US
Mailing Address - Phone:860-471-1348
Mailing Address - Fax:
Practice Address - Street 1:450 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1823
Practice Address - Country:US
Practice Address - Phone:860-412-5141
Practice Address - Fax:860-774-1656
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1155156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician