Provider Demographics
NPI:1043394885
Name:SMART VISION, LLC
Entity Type:Organization
Organization Name:SMART VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSILIN
Authorized Official - Middle Name:MAELIA
Authorized Official - Last Name:QUINT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-622-5800
Mailing Address - Street 1:255 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4933
Mailing Address - Country:US
Mailing Address - Phone:207-622-5800
Mailing Address - Fax:207-621-2790
Practice Address - Street 1:255 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4933
Practice Address - Country:US
Practice Address - Phone:207-622-5800
Practice Address - Fax:207-621-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT961152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125420101Medicaid
ME125420001Medicaid
ME125420100Medicaid
ME125420100Medicaid
ME125420101Medicaid
MEDC6123Medicare PIN