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General NPI Number Information
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NPI Number | 1467533588
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Entity Type | Organization
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Legal Business Name | BRUNSWICK EYE CARE ASSOCIATES, PA
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 331 MAINE ST SUITE 1
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-725-2161
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Fax | 207-725-9189
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Provider Business Mailing Address
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Address Line | 331 MAINE ST SUITE 1
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City | BRUNSWICK
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State | ME
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Zip | 04011-3358
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Country | US
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Telephone | 207-725-2161
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Fax | 207-725-9189
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN L DANIELS
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Credential | O.D.
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Telephone | 207-725-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 011131
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT618
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT787
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License Number State |
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT661
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License Number State |
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