Active NPI
Lee Robert McKinney, LO
- Optician
- Stratford, CT
National Provider Identifier
1336615764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1193
- Practice address
- 495 Hawley LN
Stratford, CT 06614-1514 - Phone
- (203) 375-5819
- Fax
- (203) 377-4337
- NPI assigned
- Oct 24, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmic Technician/Technologist | 156FX1100X | 1193 | CT | |
| Optician | 156FX1800X | 1193 | CT | Primary |
Addresses
Primary practice location
495 Hawley LN
Stratford, CT 06614-1514
Mailing address
495 Hawley LN
Stratford, CT 06614-1514
Phone (203) 375-5819
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114438652 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1193 | CT | MD | Ophthalmic Technician/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1336615764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "495 HAWLEY LN",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066141514",
"telephone_number": "203-375-5819",
"fax_number": "203-377-4337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 HAWLEY LN",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066141514",
"telephone_number": "203-375-5819",
"fax_number": "203-377-4337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINNEY",
"first_name": "LEE",
"middle_name": "ROBERT",
"credential": "LO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1100X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Ophthalmic",
"state": "CT",
"license": "1193",
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "1193",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114438652",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stratford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.