Healthcare Provider Details

I. General information

NPI: 1316023039
Provider Name (Legal Business Name): PETER NESIN OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 NORTHPORT AVE
BELFAST ME
04915-6060
US

IV. Provider business mailing address

PO BOX 476
BELFAST ME
04915-0476
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-2440
  • Fax: 207-338-2440
Mailing address:
  • Phone: 207-338-2440
  • Fax: 207-338-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: