Provider Demographics
NPI:1205455847
Name:CALVELLI, HANNAH GLEZEN (OD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:GLEZEN
Last Name:CALVELLI
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 1:15 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2792
Mailing Address - Country:US
Mailing Address - Phone:207-774-8277
Mailing Address - Fax:207-523-5310
Practice Address - Street 1:15 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2792
Practice Address - Country:US
Practice Address - Phone:207-523-5388
Practice Address - Fax:207-523-5310
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002884152W00000X
MEOPT1047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist