NPI 1235174889 · live from the CMS NPI Registry
Stephen Lewis Ebersole, OD
Optometrist in Lewiston, ME. National Provider Identifier 1235174889, active.
NPI record
| NPI | 1235174889 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 168 East Ave, Optometric Associates, Lewiston, ME 04240 |
| Practice phone | 207-784-3564 |
| Mailing address | 168 East Ave, Optomeric Associates PA, Lewiston, ME 04240 |
| Enumerated | June 18, 2006 |
| Last updated | January 4, 2011 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | 832TA (ME) |
| Optometrist primary | 152W00000X | OPT832TA6 (ME) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.