Healthcare Provider Details

I. General information

NPI: 1275592073
Provider Name (Legal Business Name): KIRN, EVERETT & CAMERON, OPTOMETRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST
RUMFORD ME
04276-2060
US

IV. Provider business mailing address

PO BOX 310
RUMFORD ME
04276-0310
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-4491
  • Fax: 207-364-4015
Mailing address:
  • Phone: 207-364-4491
  • Fax: 207-364-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PETER C. EVERETT
Title or Position: PARTNER
Credential: O.D.
Phone: 207-364-4491