Provider Demographics
NPI: | 1215334248 |
---|---|
Name: | EYECARE TODAY, PA |
Entity type: | Organization |
Organization Name: | EYECARE TODAY, PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | MURRAY |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 207-773-3232 |
Mailing Address - Street 1: | 449 FOREST AVE STE 8 |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04101-2008 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-773-3232 |
Mailing Address - Fax: | 207-773-3240 |
Practice Address - Street 1: | 449 FOREST AVE STE 8 |
Practice Address - Street 2: | |
Practice Address - City: | PORTLAND |
Practice Address - State: | ME |
Practice Address - Zip Code: | 04101-2008 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-773-3232 |
Practice Address - Fax: | 207-773-3240 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-11-19 |
Last Update Date: | 2015-04-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ME | OPT580 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |