Healthcare Provider Details

I. General information

NPI: 1669469052
Provider Name (Legal Business Name): JULIANN KANDRA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MAIN ST
SACO ME
04072-1514
US

IV. Provider business mailing address

323 MAIN ST
SACO ME
04072-1514
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-4560
  • Fax: 207-283-0309
Mailing address:
  • Phone: 207-284-4560
  • Fax: 207-283-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT967
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: