Provider Demographics
NPI:1407807126
Name:MORSE, PETER F (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:MORSE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MAINE MALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2312
Mailing Address - Country:US
Mailing Address - Phone:207-774-8008
Mailing Address - Fax:207-774-0990
Practice Address - Street 1:213 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2312
Practice Address - Country:US
Practice Address - Phone:207-774-8008
Practice Address - Fax:207-774-0990
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200460099Medicaid
ME038256OtherANTHEM
MET31677Medicare UPIN
MEVX1888Medicare PIN
ME200460099Medicaid