Provider Demographics
NPI:1376723130
Name:PORTER, TERE KENT (OD)
Entity type:Individual
Prefix:DR
First Name:TERE
Middle Name:KENT
Last Name:PORTER
Suffix:
Gender:M
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 206
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-0206
Mailing Address - Country:US
Mailing Address - Phone:207-743-6271
Mailing Address - Fax:207-743-2119
Practice Address - Street 1:66 PARIS ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5669
Practice Address - Country:US
Practice Address - Phone:207-743-6271
Practice Address - Fax:207-743-2119
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4682Medicare Oscar/Certification