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General NPI Number Information
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NPI Number | 1659453959
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Entity Type | Individual
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Provider Name | KIM LEE BERGERON-DUNCAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 HOPMEADOW ST SUITE 100
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City | WEATOGUE
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State | CT
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Zip | 06089-9407
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Country | US
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Telephone | 860-658-1704
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Fax | 860-651-9966
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Provider Business Mailing Address
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Address Line | 237 MEYER RD
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City | TORRINGTON
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State | CT
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Zip | 06790-2806
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Country | US
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Telephone | 860-489-4212
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2596
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License Number State | CT
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