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General NPI Number Information
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NPI Number | 1811066079
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Entity Type | Organization
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Legal Business Name | SMART VISION, LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 824 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3614
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Country | US
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Telephone | 207-947-7554
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Fax | 207-945-0085
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Provider Business Mailing Address
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Address Line | 824 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3614
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Country | US
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Telephone | 207-947-7554
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Fax | 207-945-0085
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | JESSILIN M QUINT
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Credential | OD
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Telephone | 207-947-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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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 | OPT961
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License Number State | ME
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