Provider Demographics
NPI:1992700132
Name:WOLF EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:WOLF EYE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RUTH ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-783-9653
Mailing Address - Street 1:249 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7053
Mailing Address - Country:US
Mailing Address - Phone:207-783-9653
Mailing Address - Fax:207-786-4362
Practice Address - Street 1:249 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7053
Practice Address - Country:US
Practice Address - Phone:207-783-9653
Practice Address - Fax:207-786-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36163261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1011113OtherAETNA HMO
ME490003182OtherRR MEDICARE
ME903451OtherHARVARD PILGRIM
ME0005123425OtherAETNA NON HMO
ME112050100Medicaid
ME024590OtherANTHEMBLUE CROSS
ME112050100Medicaid
ME903451OtherHARVARD PILGRIM