Provider Demographics
NPI:1659820439
Name:MIDCOAST EYE CARE, LLC
Entity Type:Organization
Organization Name:MIDCOAST EYE CARE, LLC
Other - Org Name:DAMARISCOTTA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LABREE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-594-9555
Mailing Address - Street 1:1100 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-3801
Mailing Address - Country:US
Mailing Address - Phone:207-594-9555
Mailing Address - Fax:207-594-2410
Practice Address - Street 1:1100 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3801
Practice Address - Country:US
Practice Address - Phone:207-594-9555
Practice Address - Fax:207-594-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400139096Medicare UPIN