MAINE EYE CENTER, PA

Provider Demographics

• NPI: 1720044878
• Name: MAINE EYE CENTER, PA
• Entity Type: Organization
• Organization Name: MAINE EYE CENTER, PA
• Authorized Official - Title/Position: DIRECTOR OF REVENUE CYCLE
• Authorized Official - First Name: JUDITH
• Authorized Official - Last Name: MCCANN
• Authorized Official - Phone: 848-219-2109
• Mailing Address - Street 1: 15 LOWELL ST
• Mailing Address - City: PORTLAND
• Mailing Address - State: ME
• Mailing Address - Zip Code: 04102-2776
• Mailing Address - Country: US
• Mailing Address - Phone: 207-774-8277
• Mailing Address - Fax: 207-523-5310
• Practice Address - Street 1: 15 LOWELL ST
• Practice Address - City: PORTLAND
• Practice Address - State: ME
• Practice Address - Zip Code: 04102-2776
• Practice Address - Country: US
• Practice Address - Phone: 207-774-8277
• Practice Address - Fax: 207-523-5310
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-04-25
• Last Update Date: 2023-10-12

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Multi-Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	152WC0802X	Eye and Vision Services Providers	Optometrist	Corneal and Contact Management	Group - Multi-Specialty
No	156FC0800X	Eye and Vision Services Providers	Technician/Technologist	Contact Lens	Group - Multi-Specialty
No	156FX1101X	Eye and Vision Services Providers	Technician/Technologist	Ophthalmic Assistant	Group - Multi-Specialty
No	156FX1202X	Eye and Vision Services Providers	Technician/Technologist	Optometric Technician	Group - Multi-Specialty
No	156FX1800X	Eye and Vision Services Providers	Technician/Technologist	Optician	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ME	106700000	Medicaid
ME	490000770	Other	RAILROAD FACILITY GROUP #
ME	M187212	Other	CIGNA HS FACILITY GROUP
ME	M304	Other	CIGNA HEALTHSOURCE GROUP
NH	9720	Other	NH CIGNA HEALTHSOURCE GRO
ME	E00118	Other	CHAMPUS GROUP #
ME	2359120	Other	AETNA FACILITY GROUP #
ME	106700200	Medicaid
NH	99904863	Medicaid
ME	000335	Other	ANTHEM FACILITY GROUP #
ME	106700100	Medicaid
ME	106700300	Medicaid
ME	106700300	Medicaid
ME	M187212	Other	CIGNA HS FACILITY GROUP
ME	490000770	Other	RAILROAD FACILITY GROUP #
ME	2359120	Other	AETNA FACILITY GROUP #
ME	106700000	Medicaid
ME	0407860001	Medicare NSC
NH	RE4775	Medicare PIN