Healthcare Provider Details

I. General information

NPI: 1770498867
Provider Name (Legal Business Name): NORTHERN MAINE EYEWEAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 STATE ST
PRESQUE ISLE ME
04769-2606
US

IV. Provider business mailing address

163 STATE ST
PRESQUE ISLE ME
04769-2606
US

V. Phone/Fax

Practice location:
  • Phone: 207-227-9279
  • Fax: 207-292-9904
Mailing address:
  • Phone: 207-227-9279
  • Fax: 207-292-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA THOMPSON
Title or Position: OWNER/FOUNDER
Credential: OPTICIAN
Phone: 207-227-9279