Provider Demographics
NPI:1619166014
Name:MOBILE EYE CARE OF MAINE, LLC
Entity Type:Organization
Organization Name:MOBILE EYE CARE OF MAINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:THEES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-730-1269
Mailing Address - Street 1:21 BARLEY LN
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8442
Mailing Address - Country:US
Mailing Address - Phone:207-730-1269
Mailing Address - Fax:207-883-2799
Practice Address - Street 1:21 BARLEY LN
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8442
Practice Address - Country:US
Practice Address - Phone:207-730-1269
Practice Address - Fax:207-883-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty