Provider Demographics
NPI:1790809143
Name:BOLDCOAST EYECARE, INC
Entity Type:Organization
Organization Name:BOLDCOAST EYECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-333-0323
Mailing Address - Street 1:251 US ROUTE 1
Mailing Address - Street 2:SUITE W9B
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1322
Mailing Address - Country:US
Mailing Address - Phone:207-347-3333
Mailing Address - Fax:
Practice Address - Street 1:251 US ROUTE 1
Practice Address - Street 2:SUITE W9B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1322
Practice Address - Country:US
Practice Address - Phone:207-347-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOP805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100229OtherANTHEM PROVIDER ID
ME4619720OtherAETNA PROVIDER ID