=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144314568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY W. DEMPSKI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 VA CENTER
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-623-8411
-----------------------------------------------------
Fax | 207-621-4853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 HERITAGE ROAD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04963-4649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-623-8411
-----------------------------------------------------
Fax | 207-621-4853
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 000409
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------