Healthcare Provider Details

I. General information

NPI: 1841341542
Provider Name (Legal Business Name): BUXTON EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST STE B
BUXTON ME
04093-6101
US

IV. Provider business mailing address

PO BOX 629
BAR MILLS ME
04004-0629
US

V. Phone/Fax

Practice location:
  • Phone: 207-929-3007
  • Fax: 207-929-3595
Mailing address:
  • Phone: 207-929-3007
  • Fax: 207-929-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 752
License Number StateME

VIII. Authorized Official

Name: DR. CARL E. GULLBRAND
Title or Position: OWNER
Credential: O. D.
Phone: 207-929-3007