Provider Demographics
NPI:1851607501
Name:SUNRISE EYE CARE PA
Entity Type:Organization
Organization Name:SUNRISE EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-454-2277
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0477
Mailing Address - Country:US
Mailing Address - Phone:207-255-4461
Mailing Address - Fax:207-255-8609
Practice Address - Street 1:19 COURT ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-2108
Practice Address - Country:US
Practice Address - Phone:207-255-4461
Practice Address - Fax:207-255-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME900T152W00000X
ME567T152W00000X
ME667T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126350001Medicaid
ME126350001Medicaid