Healthcare Provider Details

I. General information

NPI: 1215204961
Provider Name (Legal Business Name): MAINE PROFESSIONAL OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GLEN RD 23 POWER HOUSE MALL
WEST LEBANON NH
03784
US

IV. Provider business mailing address

8 GLEN RD 23 POWER HOUSE MALL
WEST LEBANON NH
03784
US

V. Phone/Fax

Practice location:
  • Phone: 603-298-9775
  • Fax: 603-298-5378
Mailing address:
  • Phone: 603-298-9775
  • Fax: 603-298-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH358
License Number StateNH

VIII. Authorized Official

Name: MRS. CYNTHIA E. EDMONDSON
Title or Position: OWNER
Credential: LICENSED HEARING AID
Phone: 603-298-9775