Healthcare Provider Details

I. General information

NPI: 1154604288
Provider Name (Legal Business Name): SANFORD FAMILY EYECARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 MAIN ST STE 2
SPRINGVALE ME
04083
US

IV. Provider business mailing address

462 MAIN ST SUITE 2
SPRINGDALE ME
04083
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-0400
  • Fax:
Mailing address:
  • Phone: 207-324-0400
  • Fax: 207-850-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT0882
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SARA L BROOKS
Title or Position: BILLING
Credential:
Phone: 207-324-0400