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Contact Information

EYECARE MEDICAL GROUP OPTICAL SHOP
53 SEWALL STREET
PORTLAND, ME04102
 Phone: 207-828-2020
 Fax: 207-773-7034
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for EYECARE MEDICAL GROUP OPTICAL SHOP

NPI # 1184729915
LBN Legal business name EYECARE MEDICAL GROUP OPTICAL SHOP
Authorized official LYNN SHORTY - (CHIEF OPERATING OFFIER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/14/2006
Last updated 07/31/2023 - About 3 years ago
Identifiers
ME Medicaid 109280300
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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