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Organization
EYECARE MEDICAL GROUP OPTICAL SHOP
Active
Organization
EYECARE MEDICAL GROUP OPTICAL SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN SHORTY RN, CMPE (CHIEF OPERATING OFFIER)
(207) 791-8234
Entity
Organization
Contact information
Practice address
53 SEWALL STREET, PORTLAND, ME 04102
(207) 828-2020
(207) 773-7034
Mailing address
53 SEWALL STREET, PORTLAND, ME 04102
(207) 773-9597
(207) 773-7034
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109280300
—
ME
Enumeration date
09/14/2006
Last updated
07/31/2023
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