Provider Demographics
NPI:1841341542
Name:BUXTON EYE CENTER
Entity type:Organization
Organization Name:BUXTON EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GULLBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:207-929-3007
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0629
Mailing Address - Country:US
Mailing Address - Phone:207-929-3007
Mailing Address - Fax:207-929-3595
Practice Address - Street 1:63 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6101
Practice Address - Country:US
Practice Address - Phone:207-929-3007
Practice Address - Fax:207-929-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT 752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126820000Medicaid
U16411Medicare UPIN
ME5972880001Medicare NSC
ME126820000Medicaid