Provider Demographics
NPI:1053711226
Name:LAJOIE-RAY, KIMBERLY A (LO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:LAJOIE-RAY
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3635
Mailing Address - Country:US
Mailing Address - Phone:860-219-9947
Mailing Address - Fax:860-219-9947
Practice Address - Street 1:1007 FARMINGTON AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2133
Practice Address - Country:US
Practice Address - Phone:860-232-7616
Practice Address - Fax:860-233-4565
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001608156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician