Provider Demographics
NPI:1760533269
Name:HEBERT, AMY NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:NICOLE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:309 SAINT THOMAS ST STE 213
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1278
Mailing Address - Country:US
Mailing Address - Phone:207-728-4779
Mailing Address - Fax:207-728-3727
Practice Address - Street 1:309 SAINT THOMAS ST STE 213
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1278
Practice Address - Country:US
Practice Address - Phone:207-728-4779
Practice Address - Fax:207-728-3727
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU85734Medicare UPIN