Healthcare Provider Details

I. General information

NPI: 1295855948
Provider Name (Legal Business Name): MAINE EYE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MARGINAL WAY
PORTLAND ME
04101-2438
US

IV. Provider business mailing address

15 LOWELL ST
PORTLAND ME
04102-2726
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-8277
  • Fax: 207-699-5850
Mailing address:
  • Phone: 207-774-8277
  • Fax: 207-699-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number36641
License Number StateME

VIII. Authorized Official

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