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General NPI Number Information
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NPI Number | 1568967131
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Entity Type | Organization
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Legal Business Name | CENTRAL MAINE EYE SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 249 MAIN ST
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City | LEWISTON
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State | ME
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Zip | 04240-7053
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Country | US
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Telephone | 207-783-9653
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Fax |
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Provider Business Mailing Address
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Address Line | 14201 DALLAS PKWY
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City | DALLAS
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State | TX
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Zip | 75254-2916
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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 | MARKET PRESIDENT
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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