Healthcare Provider Details

I. General information

NPI: 1043394885
Provider Name (Legal Business Name): SMART VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WESTERN AVE
AUGUSTA ME
04330-4933
US

IV. Provider business mailing address

255 WESTERN AVE
AUGUSTA ME
04330-4933
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-5800
  • Fax: 207-621-2790
Mailing address:
  • Phone: 207-622-5800
  • Fax: 207-621-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT961
License Number StateME

VIII. Authorized Official

Name: JESSILIN MAELIA QUINT
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 207-622-5800