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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