Provider Demographics
NPI:1427311950
Name:ADAMS, KELLEE E (OD)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLEE
Other - Middle Name:E
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1201 BOSTON POST RD
Mailing Address - Street 2:SUITE 2063
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2703
Mailing Address - Country:US
Mailing Address - Phone:203-878-6574
Mailing Address - Fax:
Practice Address - Street 1:1537 J ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3839
Practice Address - Country:US
Practice Address - Phone:812-675-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002856152W00000X
IN18004082A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1427311950Medicaid