1275592073 NPI number — KIRN, EVERETT & CAMERON, OPTOMETRISTS

Table of content: (NPI 1275592073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275592073 NPI number — KIRN, EVERETT & CAMERON, OPTOMETRISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRN, EVERETT & CAMERON, OPTOMETRISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275592073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUMFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04276-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-364-4491
Provider Business Mailing Address Fax Number:
207-364-4015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUMFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04276-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-364-4491
Provider Business Practice Location Address Fax Number:
207-364-4015
Provider Enumeration Date:
03/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EVERETT
Authorized Official First Name:
PETER
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
207-364-4491

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ3332 . This is a "RAILROAD MEDICARE PALMETT" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".