EYECARE MEDICAL GROUP NPI 1376599381

NPI Information

NPI: 1376599381
Provider Name: EYECARE MEDICAL GROUP
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 20D2266878

Address:
53 SEWALL STREET
PORTLAND, ME
ZIP 04102
Phone: (207) 828-2020
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EYECARE MEDICAL GROUP is an ambulatory surgical clinic center in Portland, ME. EYECARE MEDICAL GROUP NPI is 1376599381. The provider is registered as an organization entity type.

The provider's business location address is:

53 SEWALL STREET
PORTLAND, ME
ZIP 04102-625
Phone: (207) 828-2020
Fax: (207) 773-7034

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

The CLIA number assigned to this NPI record is 20D2266878 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/25/2006 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	261QA1903X	Clinic/Center	Ambulatory Surgical	36395	MAINE	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	109280100	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: 4/28/2024

NPI Synchronization or Removal

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