Provider Demographics
NPI:1184711319
Name:KENNETH F. NUZZO, O.D., P.A.
Entity type:Organization
Organization Name:KENNETH F. NUZZO, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:NUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-622-3015
Mailing Address - Street 1:31 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1440
Mailing Address - Country:US
Mailing Address - Phone:207-622-3015
Mailing Address - Fax:207-622-1299
Practice Address - Street 1:31 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1440
Practice Address - Country:US
Practice Address - Phone:207-622-3015
Practice Address - Fax:207-622-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115450000Medicaid
ME005177OtherFEDERAL ANTHEM BCBS
MEMNT779OtherHARVARD PILGRIM
MEDD0505OtherRAILROAD MEDICARE
ME005177OtherANTHEM BCBS
ME1041458OtherAETNA HEALTHCARE
MEM63500OtherCIGNA HEALTHCARE
ME410007801OtherRAILROAD MEDICARE
MEMNT779OtherHEALTH PLANS, INC.
ME005177OtherANTHEM BCBS
ME005177OtherFEDERAL ANTHEM BCBS
MEM63500OtherCIGNA HEALTHCARE
ME0370640002Medicare NSC
ME0370640001Medicare NSC