Provider Demographics
NPI:1487673349
Name:ONEAL, KERRY K (OD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:ONEAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:131 BOSTON POST RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2839
Mailing Address - Country:US
Mailing Address - Phone:860-442-5058
Mailing Address - Fax:860-443-4118
Practice Address - Street 1:131 BOSTON POST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2839
Practice Address - Country:US
Practice Address - Phone:860-442-5058
Practice Address - Fax:860-443-4118
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487673349Medicaid
CTD400009264Medicare PIN
CTU67937Medicare UPIN