EYECARE MEDICAL GROUP OPTICAL SHOP NPI 1184729915

NPI Information

NPI: 1184729915
Provider Name: EYECARE MEDICAL GROUP OPTICAL SHOP
Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization

CLIA Number: 20D0992976

Address:
53 SEWALL STREET
PORTLAND, ME
ZIP 04102
Phone: (207) 828-2020
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EYECARE MEDICAL GROUP OPTICAL SHOP is an eyewear supplier in Portland, ME. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. EYECARE MEDICAL GROUP OPTICAL SHOP NPI is 1184729915. The provider is registered as an organization entity type.

The provider's business location address is:

53 SEWALL STREET
PORTLAND, ME
ZIP 04102
Phone: (207) 828-2020
Fax: (207) 773-7034

The provider's authorized official is Lynn Shorty .
The authorized official title is Chief Operating Offier and has the following contact phone number (207) 791-8234.

The CLIA number assigned to this NPI record is 20D0992976 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/14/2006 and was last updated on 12/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	109280300	MEDICAID	MAINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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