Doctor Name: | MR. KEVIN THOMAS GRADY |
NPI Number: | 1952637266 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 811 |
Business Practice Address: | 36 W Stafford Rd Stafford Springs, CT - 060761064 |
Business Phone Number: | 8606845523 |
Business Fax Number: | 8607631313 |
Mailing Address: | 33 Somers Hill Cir, SOMERS |
State: | CT |
Postal Code: | 060711928 |
Phone Number: | 8607492020 |
Fax Number: | 8607631313 |
NPI Enumeration Date: | 10/21/2009 |
NPI Last Update Date: | 10/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |