Provider Demographics
NPI:1326039488
Name:WOLF EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:WOLF EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-783-9653
Mailing Address - Street 1:249 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7053
Mailing Address - Country:US
Mailing Address - Phone:207-783-9653
Mailing Address - Fax:207-786-4362
Practice Address - Street 1:249 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7053
Practice Address - Country:US
Practice Address - Phone:207-783-9653
Practice Address - Fax:207-786-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008301OtherNEW HAMPSHIRE MEDICAID
ME112040000Medicaid
NH30008301OtherNEW HAMPSHIRE MEDICAID