Provider Demographics
NPI:1952765356
Name:VERRILL, ALYSSA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:VERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DIRIGO DR
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1600
Mailing Address - Country:US
Mailing Address - Phone:207-942-2015
Mailing Address - Fax:207-945-6528
Practice Address - Street 1:29 DIRIGO DR
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1600
Practice Address - Country:US
Practice Address - Phone:207-942-2015
Practice Address - Fax:207-945-6528
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME000T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist