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General NPI Number Information
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NPI Number | 1487182580
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Entity Type | Organization
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Legal Business Name | RETINA & UVEITIS CONSULTANTS OF MAINE
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 336 MOUNT HOPE AVE STE 1
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City | BANGOR
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State | ME
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Zip | 04401-4236
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Country | US
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Telephone | 207-573-1509
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Fax | 207-573-1570
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Provider Business Mailing Address
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Address Line | 336 MOUNT HOPE AVE STE 1
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City | BANGOR
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State | ME
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Zip | 04401-4236
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Country | US
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Telephone | 207-573-1509
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Fax | 207-573-1570
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Authorized Official
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Title or Position | SOLE OWNER
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Name | ANTHONY S. EKONG
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Credential | MD
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Telephone | 207-573-1509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0108X
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Taxonomy Name | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
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License Number | MD21285
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD21285
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License Number State | ME
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