Provider Demographics
NPI:1952572273
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:FRED
Authorized Official - Last Name:NUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-377-6944
Mailing Address - Street 1:162 ROUTE 133
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1358
Mailing Address - Country:US
Mailing Address - Phone:207-377-6944
Mailing Address - Fax:207-377-5413
Practice Address - Street 1:162 ROUTE 133
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1358
Practice Address - Country:US
Practice Address - Phone:207-377-6944
Practice Address - Fax:207-377-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
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
MEMNT779OtherHARVARD PILGRIM
ME005177OtherANTHEM BCBS
ME005177OtherFEDERAL ANTHEM BCBS
ME115450000Medicaid
MEM63500OtherCIGNA HEALTHCARE
ME410007801OtherRAILROAD MEDICARE
ME1041458OtherAETNA HEALTHCARE
MEM63500OtherCIGNA HEALTHCARE
ME115450000Medicaid
MEGX7059Medicare PIN