1043985914 NPI number — DR. KATHRYN L REGAN OD, MS

Table of content: DR. KATHRYN L REGAN OD, MS (NPI 1043985914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043985914 NPI number — DR. KATHRYN L REGAN OD, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGAN
Provider First Name:
KATHRYN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD, MS
Provider Gender Code:
F

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:
1043985914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04102-2957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-874-2141
Provider Business Mailing Address Fax Number:
207-761-3738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-874-2141
Provider Business Practice Location Address Fax Number:
207-874-2164
Provider Enumeration Date:
08/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT-002524 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OPT.0003866 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OPT-002524 . This is a "AZ STATE LICENSE ISSUED BY BOARD OF OPTOMETRY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: OPT.0003866 . This is a "CO STATE LICENSE ISSUED BY DORA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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