Provider Demographics
NPI:1366623530
Name:MIDCOAST EYE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MIDCOAST EYE ASSOCIATES, P.A.
Other - Org Name:MIDCOAST OPTICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GENSHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-443-8141
Mailing Address - Street 1:130 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2548
Mailing Address - Country:US
Mailing Address - Phone:207-443-8141
Mailing Address - Fax:207-443-8142
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2548
Practice Address - Country:US
Practice Address - Phone:207-443-8141
Practice Address - Fax:207-443-8142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDCOAST EYE ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1366623530Medicare NSC
0321680001Medicare PIN