# RIVERSIDE EYE CENTER PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1780879510
- **Authorized official:** JANICE FOURNIER CMPE (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (207) 786-1917

## Contact information

- **Practice address:** 475 LISBON ST, LEWISTON, ME 04240-7418
- **Practice address phone:** (207) 786-2500
- **Practice address fax:** (207) 786-2503
- **Mailing address:** 193 MAIN ST, RIVERSIDE EYE CENTER, NORWAY, ME 04268-5645
- **Mailing address phone:** (207) 743-0027
- **Mailing address fax:** (207) 743-0051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 015596 | ME | Yes |

## Other

- **Enumeration date:** 09/14/2007
- **Last updated:** 08/09/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 061139 | ANTHEM | — |
| 05 | — | 325120099 | — | ME |
| 05 | — | 431545400 | — | ME |
| 01 | — | M2307901 | CIGNA | — |
| 01 | — | MM8909 | MEDICARE | — |
| 01 | — | NX3033 | MEDICARE PTAN | — |
| 01 | — | P00184354 | RAILROAD MEDICARE | — |