Provider Demographics
NPI:1295918233
Name:YORK FAMILY EYECARE
Entity type:Organization
Organization Name:YORK FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-363-7555
Mailing Address - Street 1:764 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5883
Mailing Address - Country:US
Mailing Address - Phone:207-363-7555
Mailing Address - Fax:207-363-1711
Practice Address - Street 1:764 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5883
Practice Address - Country:US
Practice Address - Phone:207-363-7555
Practice Address - Fax:207-363-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME018152OtherSTAR #
MEMNT038OtherHARVARD PILGRIM
MM6681OtherMEDICARE
ME09Y000292ME01OtherBLUE CROSS PROVIDER #
ME130570000Medicaid
MEM22891OtherCIGNA PROVIDER #
ME2237986OtherAETNA
ME5021708OtherCIGNA PROVIDER #
MM6681OtherMEDICARE