Provider Demographics
NPI:1659462174
Name:TERE AND JUDY PA
Entity Type:Organization
Organization Name:TERE AND JUDY PA
Other - Org Name:TERE K PORTER OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERE
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-743-6271
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:66 PARIS ST
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-0206
Mailing Address - Country:US
Mailing Address - Phone:207-743-6271
Mailing Address - Fax:207-743-2119
Practice Address - Street 1:66 PARIS ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-0206
Practice Address - Country:US
Practice Address - Phone:207-743-6271
Practice Address - Fax:207-743-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0075OtherHARVARD PILGRIM
ME0502OtherEYEMED
220953OtherCOLE MANAGE VISION
ME0624710001OtherDMERC
119862OtherANTHEM
1324328OtherCIGNA
MN0075OtherHARVARD PILGRIM
119862OtherANTHEM