Provider Demographics
NPI:1437182383
Name:MAINE OPTOMETRY PA
Entity Type:Organization
Organization Name:MAINE OPTOMETRY PA
Other - Org Name:MAINE OPTOMETRY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-729-8474
Mailing Address - Street 1:82 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2015
Mailing Address - Country:US
Mailing Address - Phone:207-729-8474
Mailing Address - Fax:207-729-8955
Practice Address - Street 1:82 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2015
Practice Address - Country:US
Practice Address - Phone:207-729-8474
Practice Address - Fax:207-729-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3005Medicare PIN
ME0394330001Medicare NSC