Healthcare Provider Details

I. General information

NPI: 1518591593
Provider Name (Legal Business Name): MAINE EYE DOCTORS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FIRST PARK DR STE A
OAKLAND ME
04963-5370
US

IV. Provider business mailing address

25 FIRST PARK DR STE A
OAKLAND ME
04963-5370
US

V. Phone/Fax

Practice location:
  • Phone: 207-314-5728
  • Fax:
Mailing address:
  • Phone: 207-820-2020
  • Fax: 207-616-3437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ZLATKO NECEVSKI
Title or Position: CFO
Credential: MBA
Phone: 207-820-2020