Provider Demographics
NPI:1710953336
Name:MAINE EYE CARE ASSOCIATES
Entity Type:Organization
Organization Name:MAINE EYE CARE ASSOCIATES
Other - Org Name:EYE CARE OF MAINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-873-2731
Mailing Address - Street 1:325A KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4517
Mailing Address - Country:US
Mailing Address - Phone:207-873-2731
Mailing Address - Fax:207-873-1106
Practice Address - Street 1:325A KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4517
Practice Address - Country:US
Practice Address - Phone:207-873-2731
Practice Address - Fax:207-873-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME105500000Medicaid
0222910001Medicare NSC
MEMA046200Medicare PIN