Provider Demographics
NPI:1700034857
Name:ELLSWORTH UVEITIS & RETINA CARE, PA
Entity Type:Organization
Organization Name:ELLSWORTH UVEITIS & RETINA CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-669-4390
Mailing Address - Street 1:35 EASTWARD LN
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1744
Mailing Address - Country:US
Mailing Address - Phone:207-669-4390
Mailing Address - Fax:207-669-4363
Practice Address - Street 1:35 EASTWARD LN
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1744
Practice Address - Country:US
Practice Address - Phone:207-669-4390
Practice Address - Fax:207-669-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015633207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty