Provider Demographics
NPI:1467533588
Name:BRUNSWICK EYE CARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:BRUNSWICK EYE CARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-725-2161
Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-725-2161
Mailing Address - Fax:207-725-9189
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-725-2161
Practice Address - Fax:207-725-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OPT661152W00000X
MEOPT618152W00000X
OPT787152W00000X
ME011131207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111880000Medicaid
ME152623Medicare ID - Type UnspecifiedPROVIDER BILLING ID
ME111880000Medicaid