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General NPI Number Information
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NPI Number | 1063401693
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Entity Type | Organization
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Legal Business Name | CASCO BAY EYECARE LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 144 THADEUS ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6259
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Country | US
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Telephone | 207-885-8686
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Fax | 207-883-7154
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Provider Business Mailing Address
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Address Line | PO BOX 7487
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City | PORTLAND
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State | ME
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Zip | 04112-7487
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Country | US
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Telephone | 207-885-8686
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Fax | 207-883-7154
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Authorized Official
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Title or Position | GROUP ADMINISTRATOR
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Name | MS. REBECCA DARLING
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Credential |
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Telephone | 207-885-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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