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General NPI Number Information
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NPI Number | 1518221142
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Entity Type | Individual
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Provider Name | CAITLYN KENNEDY MITCHELL O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 87 GRANDVIEW AVE
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City | WATERBURY
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State | CT
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Zip | 06708-2514
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Country | US
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Telephone | 203-574-2020
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Fax | 203-465-1481
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Provider Business Mailing Address
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Address Line | 69 BUCK HILL RD
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City | RIDGEFIELD
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State | CT
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Zip | 06877-2702
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Country | US
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Telephone | 845-216-1195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TUV007835-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3251
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007835
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License Number State | NY
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