=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518072602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN M LORD OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MAIN RD N SUITE A
-----------------------------------------------------
City | HAMPDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04444-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-862-6169
-----------------------------------------------------
Fax | 207-862-4333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 MAIN RD N SUITE A
-----------------------------------------------------
City | HAMPDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04444-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-862-6169
-----------------------------------------------------
Fax | 207-862-4333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT769
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------