Healthcare Provider Details

I. General information

NPI: 1255526323
Provider Name (Legal Business Name): MCCORMICK AND BOUCHARD EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EDWARDS AVE
DAMARISCOTTA ME
04543-4252
US

IV. Provider business mailing address

5 EDWARD AVE
DAMARISCOTTA ME
04543-4252
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-3049
  • Fax: 207-563-3904
Mailing address:
  • Phone: 207-563-3049
  • Fax: 207-563-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHELLE BOUCHARD
Title or Position: OWNER
Credential: OD
Phone: 207-563-8064