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Individual

DR. CHARLES A CIVIELLO JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
105 FOREST AVE, BANGOR, ME 04401-5316
(207) 942-5597
(207) 942-5597
Mailing address
PO BOX 8064, BANGOR, ME 04402-8064
(207) 942-5597
(207) 942-5597

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
621TA
ME

Other

Enumeration date
09/04/2006
Last updated
07/08/2007
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