Provider Demographics
NPI:1851542948
Name:ASSOCIATED EYE CARE
Entity Type:Organization
Organization Name:ASSOCIATED EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANVRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-324-8888
Mailing Address - Street 1:272 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-1815
Mailing Address - Country:US
Mailing Address - Phone:207-324-8888
Mailing Address - Fax:207-490-1716
Practice Address - Street 1:272 COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:MAINE
Practice Address - State:ME
Practice Address - Zip Code:04073-1815
Practice Address - Country:US
Practice Address - Phone:207-324-8888
Practice Address - Fax:207-490-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOPT901OtherSTATE LICENCE NUMBER