Healthcare Provider Details

I. General information

NPI: 1467533588
Provider Name (Legal Business Name): BRUNSWICK EYE CARE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 MAINE ST SUITE 1
BRUNSWICK ME
04011-3358
US

IV. Provider business mailing address

331 MAINE ST SUITE 1
BRUNSWICK ME
04011-3358
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-2161
  • Fax: 207-725-9189
Mailing address:
  • Phone: 207-725-2161
  • Fax: 207-725-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT661
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT618
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT787
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number011131
License Number StateME

VIII. Authorized Official

Name: BRIAN L DANIELS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 207-725-2161