Provider Demographics
NPI:1144330853
Name:FARMER, LARRY E (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:FARMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-0701
Mailing Address - Country:US
Mailing Address - Phone:207-743-7751
Mailing Address - Fax:207-743-0913
Practice Address - Street 1:39 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5501
Practice Address - Country:US
Practice Address - Phone:207-743-7751
Practice Address - Fax:207-743-0913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME710342Medicare PIN
ME0201640001Medicare NSC