Basic Information
| Provider Information | |||||||||
| NPI: | 1619046240 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOLF EYE ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077839653 | ||||||||
| FaxNumber: | 2077864362 | ||||||||
| Practice Location | |||||||||
| Address1: | 249 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077839653 | ||||||||
| FaxNumber: | 2077864362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | WOLF | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | PEACARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OPTHALMOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2077839653 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOLF EYE ASSOCIATES PA | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.