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General NPI Number Information
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NPI Number | 1215204961
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Entity Type | Organization
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Legal Business Name | MAINE PROFESSIONAL OPTICIANS
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 8 GLEN RD 23 POWER HOUSE MALL
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City | WEST LEBANON
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State | NH
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Zip | 03784
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Country | US
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Telephone | 603-298-9775
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Fax | 603-298-5378
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Provider Business Mailing Address
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Address Line | 8 GLEN RD 23 POWER HOUSE MALL
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City | WEST LEBANON
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State | NH
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Zip | 03784
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Country | US
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Telephone | 603-298-9775
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Fax | 603-298-5378
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CYNTHIA E. EDMONDSON
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Credential | LICENSED HEARING AID
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Telephone | 603-298-9775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | H358
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License Number State | NH
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