Healthcare Provider Details

I. General information

NPI: 1750458931
Provider Name (Legal Business Name): KERRY A KAPLAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MAINE AVE
FARMINGDALE ME
04344-4515
US

IV. Provider business mailing address

PO BOX 1438
WATERVILLE ME
04903-1438
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-5800
  • Fax:
Mailing address:
  • Phone: 207-872-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT823
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: