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General NPI Number Information
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NPI Number | 1447343819
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Entity Type | Organization
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Legal Business Name | FAMILY EYE HEALTH & CONTACT LENS CENTER
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 220 SABATTUS ST
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City | LEWISTON
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State | ME
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Zip | 04240-6347
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Country | US
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Telephone | 207-782-9501
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Fax | 207-782-3565
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Provider Business Mailing Address
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Address Line | 220 SABATTUS ST
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City | LEWISTON
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State | ME
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Zip | 04240-6347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SHERIDON GOVE
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Credential | OD
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Telephone | 207-782-9501
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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 | OPT602
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License Number State | ME
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