Provider Demographics
NPI:1063401693
Name:CASCO BAY EYECARE LLC
Entity type:Organization
Organization Name:CASCO BAY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-8686
Mailing Address - Street 1:PO BOX 7487
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112-7487
Mailing Address - Country:US
Mailing Address - Phone:207-885-8686
Mailing Address - Fax:207-883-7154
Practice Address - Street 1:144 THADEUS ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6259
Practice Address - Country:US
Practice Address - Phone:207-885-8686
Practice Address - Fax:207-883-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154790000Medicaid
ME154790001Medicaid
ME154790003Medicaid
ME154790002Medicaid
ME154790004Medicaid