Healthcare Provider Details

I. General information

NPI: 1639156011
Provider Name (Legal Business Name): ASSOCIATED EYE CARE OPHTHALMOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 COTTAGE ST
SANFORD ME
04073-1815
US

IV. Provider business mailing address

272 COTTAGE ST
SANFORD ME
04073-1815
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-7946
  • Fax: 324-636-5023
Mailing address:
  • Phone: 207-324-7946
  • Fax: 324-636-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number011998
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number015113
License Number StateME

VIII. Authorized Official

Name: JENNIFER BREAREY
Title or Position: OPHTHALMIC MANAGER
Credential:
Phone: 207-324-7946