Healthcare Provider Details

I. General information

NPI: 1265754519
Provider Name (Legal Business Name): SPECS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 ROOSEVELT TRAIL
SOUTH CASCO ME
04077
US

IV. Provider business mailing address

PO BOX 200
SOUTH CASCO ME
04077-0200
US

V. Phone/Fax

Practice location:
  • Phone: 207-655-2020
  • Fax: 207-655-7770
Mailing address:
  • Phone: 207-655-2020
  • Fax: 207-655-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number760
License Number StateME

VIII. Authorized Official

Name: THOMAS VINCENT GORDON
Title or Position: OWNER
Credential: OD
Phone: 207-655-2020