Thomas Hwnry Dwelley, O. D.
Individual provider Active NPI Optometrist · Bangor, ME
NPI 1629147442 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629147442
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 215861 (ME)
- Practice address
- 336 Mount Hope Ave
Suite 6
Bangor, ME 04401-4236 - Phone
- (207) 947-4481
- Fax
- (207) 947-4482
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 215861 | ME | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 215861 | ME | Yes |
Addresses
Primary practice location
336 Mount Hope Ave
Suite 6
Bangor, ME 04401-4236
Mailing address
336 Mount Hope Ave
Suite 6
Bangor, ME 04401-4236
Phone (207) 947-4481
Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.