Provider Demographics
NPI:1215204961
Name:MAINE PROFESSIONAL OPTICIANS
Entity Type:Organization
Organization Name:MAINE PROFESSIONAL OPTICIANS
Other - Org Name:POWER HOUSE HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED HEARING AID
Authorized Official - Phone:603-298-9775
Mailing Address - Street 1:8 GLEN RD
Mailing Address - Street 2:23 POWER HOUSE MALL
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784
Mailing Address - Country:US
Mailing Address - Phone:603-298-9775
Mailing Address - Fax:603-298-5378
Practice Address - Street 1:8 GLEN RD
Practice Address - Street 2:23 POWER HOUSE MALL
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784
Practice Address - Country:US
Practice Address - Phone:603-298-9775
Practice Address - Fax:603-298-5378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE PROFESSIONAL OPTICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH358237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty