Healthcare Provider Details

I. General information

NPI: 1518072602
Provider Name (Legal Business Name): STEVEN M LORD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAIN RD N SUITE A
HAMPDEN ME
04444-1307
US

IV. Provider business mailing address

50 MAIN RD N SUITE A
HAMPDEN ME
04444-1307
US

V. Phone/Fax

Practice location:
  • Phone: 207-862-6169
  • Fax: 207-862-4333
Mailing address:
  • Phone: 207-862-6169
  • Fax: 207-862-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT769
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: