Provider Demographics
NPI:1144845520
Name:BILSKI, KERRY (RDO)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:BILSKI
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1816
Mailing Address - Country:US
Mailing Address - Phone:413-592-1199
Mailing Address - Fax:413-592-4951
Practice Address - Street 1:33 GROVE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1816
Practice Address - Country:US
Practice Address - Phone:413-592-1199
Practice Address - Fax:413-592-4951
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5818156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician