Provider Demographics
NPI:1740372879
Name:KENSINGTON OPTICIANS LLC
Entity type:Organization
Organization Name:KENSINGTON OPTICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WICKE
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:860-828-6684
Mailing Address - Street 1:7 WEBSTER SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2326
Mailing Address - Country:US
Mailing Address - Phone:860-828-6684
Mailing Address - Fax:860-828-1467
Practice Address - Street 1:7 WEBSTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2326
Practice Address - Country:US
Practice Address - Phone:860-828-6684
Practice Address - Fax:860-828-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1027156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty