Provider Demographics
NPI:1164597928
Name:CASCO BAY EYECARE LLC
Entity Type:Organization
Organization Name:CASCO BAY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANASTASIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-885-8686
Mailing Address - Street 1:PO BOX 7487
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112
Mailing Address - Country:US
Mailing Address - Phone:207-885-8686
Mailing Address - Fax:207-883-7154
Practice Address - Street 1:256 US ROUTE ONE
Practice Address - Street 2:SUITE 5
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-781-5580
Practice Address - Fax:207-781-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1201070005Medicare ID - Type Unspecified