Organization
WOLF EYE ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH ANNE BROCHU (AUTHORIZED OFFICIAL)
(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
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
36163
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005123425
AETNA NON HMO
ME
01
—
024590
ANTHEMBLUE CROSS
ME
01
—
1011113
AETNA HMO
ME
05
—
112050100
—
ME
01
—
490003182
RR MEDICARE
ME
01
—
903451
HARVARD PILGRIM
ME
Enumeration date
06/15/2005
Last updated
12/10/2018
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