Provider Demographics
NPI:1104252238
Name:MIDCOAST EYE ASSOCIATES
Entity type:Organization
Organization Name:MIDCOAST EYE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GENSHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-443-6626
Mailing Address - Street 1:130 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2599
Mailing Address - Country:US
Mailing Address - Phone:207-443-8141
Mailing Address - Fax:207-443-8142
Practice Address - Street 1:8 MASON ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1514
Practice Address - Country:US
Practice Address - Phone:207-729-7979
Practice Address - Fax:207-729-7979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDCOAST EYE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty