Provider Demographics
NPI:1649351552
Name:LARY, STEVEN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:LARY
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MICA CT
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1776
Mailing Address - Country:US
Mailing Address - Phone:207-557-5996
Mailing Address - Fax:
Practice Address - Street 1:1039 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3628
Practice Address - Country:US
Practice Address - Phone:207-775-6533
Practice Address - Fax:207-775-2702
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126090000Medicaid
ME126090000Medicaid
MEMM4537Medicare PIN
MET79564Medicare UPIN