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NPI Code Detail

MEDICARE: KIMBERLY RAUCCI OD

MEDICARE:   KIMBERLY  RAUCCI  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3090CT

General Provider Information

NPI Number : 1578030458
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY RAUCCI OD
Provider Business Mailing Address
First Line : 114 CORONA DR
Second Line :
City : MILFORD
State : CT
Zip : 06460-3514
Country : US
Telephone Number : 203-606-6062
Fax Number :
Provider Business Practice Location Address
First Line : 775 MAIN ST
Second Line :
City : STRATFORD
State : CT
Zip : 06615-7406
Country : US
Telephone Number : 203-377-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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Directions to “ KIMBERLY RAUCCI OD” Practice Location

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