Provider Demographics
NPI:1972774107
Name:PETER NESIN, OPTICIAN
Entity Type:Organization
Organization Name:PETER NESIN, OPTICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NESIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-2440
Mailing Address - Street 1:158 NORTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6060
Mailing Address - Country:US
Mailing Address - Phone:207-338-2440
Mailing Address - Fax:207-338-2440
Practice Address - Street 1:158 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6060
Practice Address - Country:US
Practice Address - Phone:207-338-2440
Practice Address - Fax:207-338-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110560000Medicaid
ME6761910001Medicare NSC