Provider Demographics
NPI:1386821114
Name:NORTHERN EYE CARE P A
Entity Type:Organization
Organization Name:NORTHERN EYE CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HAINES
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:207-474-8850
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-0152
Mailing Address - Country:US
Mailing Address - Phone:207-474-8850
Mailing Address - Fax:207-474-7372
Practice Address - Street 1:110 PERHAM ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1520
Practice Address - Country:US
Practice Address - Phone:207-474-8850
Practice Address - Fax:207-474-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007644332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0449140001Medicare NSC