MEDICARE: NORTHERN EYE CARE P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	007644	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316114945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN EYE CARE P A

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	SKOWHEGAN
State	:	ME
Zip	:	04976-0066
Country	:	US
Telephone Number	:	207-474-8850
Fax Number	:	207-474-7372

Provider Business Practice Location Address
First Line	:	56 MAIN ST
Second Line	:
City	:	SKOWHEGAN
State	:	ME
Zip	:	04976-1146
Country	:	US
Telephone Number	:	207-474-8850
Fax Number	:	207-474-7372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT HAINES NICHOLSON
Credential	:	M D
Telephone Number	:	207-474-8850

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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Directions to “NORTHERN EYE CARE P A ” Practice Location

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