# NORTHEAST RETINA ASSOCIATES, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124005590
- **Authorized official:** JENNIFER BREAREY (OPHTHALMIC MANAGER)
- **Authorized official phone:** (207) 324-3380

## Contact information

- **Practice address:** 272 COTTAGE ST, SANFORD, ME 04073-1815
- **Practice address phone:** (207) 324-3380
- **Practice address fax:** (207) 636-5023
- **Mailing address:** 272 COTTAGE ST, SANFORD, ME 04073-1815
- **Mailing address phone:** (207) 324-3380
- **Mailing address fax:** (207) 636-5023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 013866 | ME | Yes |
| 207W00000X | Ophthalmology Physician | 9375 | NH | — |

## Other

- **Enumeration date:** 12/28/2005
- **Last updated:** 08/22/2020