Provider Demographics
NPI:1811066079
Name:SMART VISION, LLC
Entity type:Organization
Organization Name:SMART VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSILIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUINT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-947-7554
Mailing Address - Street 1:824 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3614
Mailing Address - Country:US
Mailing Address - Phone:207-947-7554
Mailing Address - Fax:207-945-0085
Practice Address - Street 1:824 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3614
Practice Address - Country:US
Practice Address - Phone:207-947-7554
Practice Address - Fax:207-945-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
MEOPT961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME44665OtherDAVIS VISION
ME125420101Medicaid
ME44665OtherDAVIS VISION
ME125420101Medicaid
ME0699960004Medicare NSC