Provider Demographics
NPI:1891053005
Name:NATHAN CORBELL, PHD, OD, INC
Entity Type:Organization
Organization Name:NATHAN CORBELL, PHD, OD, INC
Other - Org Name:SEACOAST VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-396-6603
Mailing Address - Street 1:25 HANNAFORD DR.
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9057
Mailing Address - Country:US
Mailing Address - Phone:207-396-6603
Mailing Address - Fax:207-396-6604
Practice Address - Street 1:25 HANNAFORD DR.
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9057
Practice Address - Country:US
Practice Address - Phone:207-396-6603
Practice Address - Fax:207-396-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000958602OtherMEDICARE
ME1215133541Medicaid
ME1215133541Medicaid