Provider Demographics
NPI:1184827552
Name:KATHRYN DINGLEY GURNEY
Entity Type:Organization
Organization Name:KATHRYN DINGLEY GURNEY
Other - Org Name:FAMILY OPTOMETRY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:DINGLEY
Authorized Official - Last Name:GURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-778-2100
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-0190
Mailing Address - Country:US
Mailing Address - Phone:207-778-2100
Mailing Address - Fax:207-778-6590
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1818
Practice Address - Country:US
Practice Address - Phone:207-778-2100
Practice Address - Fax:207-778-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432465300Medicaid
ME1104887900OtherINDIVIDUAL NPI
MEMM7433Medicare ID - Type Unspecified
MET31671Medicare UPIN
ME432465300Medicaid