Organization
THE IRIS NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN TRABOLD (DIR. OF FINANCE & ADMIN)
(207) 774-6273
Entity
Organization
Contact information
Practice address
189 PARK AVE, PORTLAND, ME 04102-2909
(207) 774-6273
(207) 774-0679
Mailing address
189 PARK AVE, PORTLAND, ME 04102-2909
(207) 774-6273
(207) 774-0679
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
—
—
Other
Enumeration date
08/14/2006
Last updated
06/13/2013
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