Healthcare Provider Details

I. General information

NPI: 1245309400
Provider Name (Legal Business Name): SMART VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MAINE AVE
FARMINGDALE ME
04344-4515
US

IV. Provider business mailing address

210 MAINE AVE
FARMINGDALE ME
04344-4515
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-5800
  • Fax: 207-588-0743
Mailing address:
  • Phone: 207-582-5800
  • Fax: 207-588-0743

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 M QUINT
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 207-582-5800