Provider Demographics
NPI:1649356700
Name:VISION CARE OF MAINE, LLC OPTOMETRY GROUP
Entity type:Organization
Organization Name:VISION CARE OF MAINE, LLC OPTOMETRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-0300
Mailing Address - Street 1:1 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-945-6200
Mailing Address - Fax:207-990-3015
Practice Address - Street 1:1 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-945-6200
Practice Address - Fax:207-990-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1649356700OtherDMERC
ME132650100Medicaid
ME1275780001Medicare NSC
MEMM8033Medicare ID - Type Unspecified