Healthcare Provider Details

I. General information

NPI: 1720044878
Provider Name (Legal Business Name): MAINE EYE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LOWELL ST
PORTLAND ME
04102-2776
US

IV. Provider business mailing address

15 LOWELL ST
PORTLAND ME
04102-2776
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-8277
  • Fax: 207-523-5310
Mailing address:
  • Phone: 207-774-8277
  • Fax: 207-523-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDITH MCCANN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 848-219-2109