Provider Demographics
NPI:1487673349
Name:O'NEAL, KERRY K (OD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:ONEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:221 ADDISON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5608
Mailing Address - Country:US
Mailing Address - Phone:860-838-3838
Mailing Address - Fax:860-838-3840
Practice Address - Street 1:221 ADDISON RD STE 105
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5608
Practice Address - Country:US
Practice Address - Phone:860-838-3838
Practice Address - Fax:860-838-3840
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487673349Medicaid
CTD400009264Medicare PIN
CTU67937Medicare UPIN