Individual
DR. DOUGLAS J. HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
168 EAST AVE, LEWISTON, ME 04240-5626
(207) 784-3564
(207) 782-2541
Mailing address
168 EAST AVE, LEWISTON, ME 04240-5626
(207) 784-3564
(207) 782-2541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT833
ME
152WC0802X
Corneal and Contact Management Optometrist
OPT833
ME
152WX0102X
Occupational Vision Optometrist
OPT833
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025957
ANTHEM-BC/BS
ME
01
—
0324520001
DME
ME
05
—
322020099
—
ME
Enumeration date
09/22/2005
Last updated
01/04/2011
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