MEDICARE: HARBOR VIEW EYE CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760441042	OTHER	ME	KRISHNA KRITHIVAS NPI#
2	1851356588	OTHER	ME	DAVID HEWARD OD NPI #

General Provider Information

NPI Number	:	1073773487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR VIEW EYE CARE, LLC

Provider Business Mailing Address
First Line	:	743 BROADWAY
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4419
Country	:	US
Telephone Number	:	207-799-3031
Fax Number	:	207-799-9005

Provider Business Practice Location Address
First Line	:	743 BROADWAY
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4419
Country	:	US
Telephone Number	:	207-799-3031
Fax Number	:	207-799-9005

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH D HEWARD
Credential	:	O.D.
Telephone Number	:	207-799-3031

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	08/08/2012

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