Healthcare Provider Details

I. General information

NPI: 1992835961
Provider Name (Legal Business Name): EYE CARE & EYE WEAR CENTER OF MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MAIN ST
WESTBROOK ME
04092-4808
US

IV. Provider business mailing address

151 MAIN ST
WESTBROOK ME
04092-4808
US

V. Phone/Fax

Practice location:
  • Phone: 207-854-1801
  • Fax: 207-854-0260
Mailing address:
  • Phone: 207-854-1801
  • Fax: 207-854-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA G HENNESSEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 207-854-1801