Healthcare Provider Details

I. General information

NPI: 1295918233
Provider Name (Legal Business Name): YORK FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 US ROUTE 1
YORK ME
03909-5883
US

IV. Provider business mailing address

764 US ROUTE 1
YORK ME
03909-5883
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-7555
  • Fax: 207-363-1711
Mailing address:
  • Phone: 207-363-7555
  • Fax: 207-363-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT729
License Number StateME

VIII. Authorized Official

Name: DR. SAMMY LEE PELLETIER
Title or Position: PRESIDENT
Credential: OD
Phone: 207-363-7555