Healthcare Provider Details

I. General information

NPI: 1508931361
Provider Name (Legal Business Name): CASCO BAY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MIDDLE STREET
PORTLAND ME
04101
US

IV. Provider business mailing address

PO BOX 7487
PORTLAND ME
04112
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-2020
  • Fax: 207-773-2447
Mailing address:
  • Phone: 207-885-8686
  • Fax: 207-883-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ANASTASIO
Title or Position: PRESIDENT
Credential: OD
Phone: 207-885-8686