Provider Demographics
NPI:1629147442
Name:DWELLEY, THOMAS HWNRY (O D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HWNRY
Last Name:DWELLEY
Suffix:
Gender:M
Credentials:O D
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:336 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4236
Mailing Address - Country:US
Mailing Address - Phone:207-947-4481
Mailing Address - Fax:207-947-4482
Practice Address - Street 1:336 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4236
Practice Address - Country:US
Practice Address - Phone:207-947-4481
Practice Address - Fax:207-947-4482
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME215861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist