Provider Demographics
NPI:1669469052
Name:KANDRA, JULIANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIANN
Middle Name:
Last Name:KANDRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1514
Mailing Address - Country:US
Mailing Address - Phone:207-284-4560
Mailing Address - Fax:207-283-0309
Practice Address - Street 1:323 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1514
Practice Address - Country:US
Practice Address - Phone:207-284-4560
Practice Address - Fax:207-283-0309
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163140Medicare PIN
AZZ163145Medicare PIN
AZZ162079Medicare PIN
AZZ163142Medicare PIN
AZZ163144Medicare PIN
AZZ162075Medicare PIN
AZZ162077Medicare PIN
AZZ163143Medicare PIN
AZU78218Medicare UPIN
AZZ82276Medicare PIN
AZZ163141Medicare PIN
AZZ162074Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN