Provider Demographics
NPI:1750338414
Name:TICHY, KURT JOSEPH (OD)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:JOSEPH
Last Name:TICHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1300
Mailing Address - Country:US
Mailing Address - Phone:203-377-3937
Mailing Address - Fax:888-741-0620
Practice Address - Street 1:7365 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1300
Practice Address - Country:US
Practice Address - Phone:203-377-3937
Practice Address - Fax:888-741-0620
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004147270Medicaid
CT410000621Medicare ID - Type Unspecified
CT004147270Medicaid