1447343819 NPI number — FAMILY EYE HEALTH & CONTACT LENS CENTER

Table of content: (NPI 1447343819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447343819 NPI number — FAMILY EYE HEALTH & CONTACT LENS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY EYE HEALTH & CONTACT LENS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1447343819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 SABATTUS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240-6347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 SABATTUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-6347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-782-9501
Provider Business Practice Location Address Fax Number:
207-782-3565
Provider Enumeration Date:
09/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOVE
Authorized Official First Name:
SHERIDON
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
207-782-9501

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT602 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M52420 . This is a "CIGNA HEALTHSOURCE #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 410004189 . This is a "MEDICARE TRAVELERS ID #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 105560000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000023 . This is a "ANTHEM ID #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 006524082 . This is a "CIGNA ID #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 006524082 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com