Provider Demographics
NPI:1356470645
Name:CARIBOU EYECARE, P.A.
Entity Type:Organization
Organization Name:CARIBOU EYECARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-498-2538
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0280
Mailing Address - Country:US
Mailing Address - Phone:207-498-2538
Mailing Address - Fax:207-498-2539
Practice Address - Street 1:43 HATCH DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2161
Practice Address - Country:US
Practice Address - Phone:207-498-2538
Practice Address - Fax:207-498-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME113100000Medicaid
ME703727Medicare ID - Type Unspecified
ME0180940001Medicare NSC