Provider Demographics
NPI:1750458931
Name:KAPLAN, KERRY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:A
Last Name:KAPLAN
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:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-1438
Mailing Address - Country:US
Mailing Address - Phone:207-872-2797
Mailing Address - Fax:
Practice Address - Street 1:210 MAINE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-4515
Practice Address - Country:US
Practice Address - Phone:207-582-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME122670000Medicaid
ME122670000Medicaid