Organization
WOLF EYE ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH P WOLF M.D. (OPHTHALMOLOGIST/OWNER)
(207) 783-9653
Entity
Organization
Contact information
Practice address
249 MAIN ST, LEWISTON, ME 04240-7053
(207) 783-9653
(207) 786-4362
Mailing address
249 MAIN ST, LEWISTON, ME 04240-7053
(207) 783-9653
(207) 786-4362
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112040000
—
ME
01
—
30008301
NEW HAMPSHIRE MEDICAID
NH
Enumeration date
10/28/2005
Last updated
08/03/2009
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