Healthcare Provider Details

I. General information

NPI: 1447343926
Provider Name (Legal Business Name): KITTERY OPTOMETRIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 US ROUTE 1 BYP SUITE A
KITTERY ME
03904-1570
US

IV. Provider business mailing address

99 US ROUTE 1 BYP SUITE A
KITTERY ME
03904-1570
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-0410
  • Fax: 207-439-8353
Mailing address:
  • Phone: 207-439-0410
  • Fax: 207-439-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN M WEBB
Title or Position: PARTNER
Credential: O.D.
Phone: 207-439-0410