=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972783181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHERINE J. VARNUM O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2007
-----------------------------------------------------
Last Update Date | 03/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 ACADEMY ST
-----------------------------------------------------
City | PRESQUE ISLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04769-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-764-1900
-----------------------------------------------------
Fax | 207-764-4900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 ACADEMY ST
-----------------------------------------------------
City | PRESQUE ISLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04769-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-764-1900
-----------------------------------------------------
Fax | 207-764-4900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHERINE J VARNUM
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 207-764-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT754
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------