Provider Demographics
NPI:1992835961
Name:EYE CARE & EYE WEAR CENTER OF MAINE
Entity Type:Organization
Organization Name:EYE CARE & EYE WEAR CENTER OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-1801
Mailing Address - Street 1:151 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4808
Mailing Address - Country:US
Mailing Address - Phone:207-854-1801
Mailing Address - Fax:207-854-0260
Practice Address - Street 1:151 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4808
Practice Address - Country:US
Practice Address - Phone:207-854-1801
Practice Address - Fax:207-854-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107830000Medicaid
MEC13901OtherRAILROAD MEDICARE
MEG0116OtherANTHEM
ME0468580001Medicare NSC
MEMM0713Medicare PIN