Provider Demographics
NPI:1487182580
Name:RETINA & UVEITIS CONSULTANTS OF MAINE
Entity Type:Organization
Organization Name:RETINA & UVEITIS CONSULTANTS OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-573-1509
Mailing Address - Street 1:336 MOUNT HOPE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4236
Mailing Address - Country:US
Mailing Address - Phone:207-573-1509
Mailing Address - Fax:207-573-1570
Practice Address - Street 1:336 MOUNT HOPE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4236
Practice Address - Country:US
Practice Address - Phone:207-573-1509
Practice Address - Fax:207-573-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21285207WX0107X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Single Specialty