Provider Demographics
NPI:1447343819
Name:FAMILY EYE HEALTH & CONTACT LENS CENTER
Entity type:Organization
Organization Name:FAMILY EYE HEALTH & CONTACT LENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-782-9501
Mailing Address - Street 1:220 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6347
Practice Address - Country:US
Practice Address - Phone:207-782-9501
Practice Address - Fax:207-782-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM52420OtherCIGNA HEALTHSOURCE #
ME410004189OtherMEDICARE TRAVELERS ID #
ME105560000Medicaid
ME000023OtherANTHEM ID #
ME006524082OtherCIGNA ID #
ME006524082OtherAETNA PROVIDER #
MEM52420OtherCIGNA HEALTHSOURCE #
ME410004189OtherMEDICARE TRAVELERS ID #