Healthcare Provider Details

I. General information

NPI: 1326039488
Provider Name (Legal Business Name): WOLF EYE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 MAIN ST
LEWISTON ME
04240-7053
US

IV. Provider business mailing address

249 MAIN ST
LEWISTON ME
04240-7053
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-9653
  • Fax: 207-786-4362
Mailing address:
  • Phone: 207-783-9653
  • Fax: 207-786-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH P WOLF
Title or Position: OPHTHALMOLOGIST/OWNER
Credential: M.D.
Phone: 207-783-9653