Healthcare Provider Details

I. General information

NPI: 1487297073
Provider Name (Legal Business Name): SOUTH PARIS EYECARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 MAIN ST STE B
SOUTH PARIS ME
04281-1621
US

IV. Provider business mailing address

177 MAIN ST STE B
SOUTH PARIS ME
04281-1621
US

V. Phone/Fax

Practice location:
  • Phone: 207-744-2447
  • Fax:
Mailing address:
  • Phone: 207-744-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT FULTON MURRAY III
Title or Position: PRESIDENT
Credential: OD
Phone: 207-744-2447