Provider Demographics
NPI:1447447149
Name:EYE CENTER OF CENTRAL MAINE
Entity type:Organization
Organization Name:EYE CENTER OF CENTRAL MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-873-6048
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4501
Mailing Address - Country:US
Mailing Address - Phone:207-873-6048
Mailing Address - Fax:207-877-9513
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4501
Practice Address - Country:US
Practice Address - Phone:207-873-6048
Practice Address - Fax:207-877-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013307207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME290130099Medicaid
ME042733OtherBLUE SHEILD
ME180043475OtherRR MEDICARE
ME691518002OtherCIGNA
ME2590268OtherAETNA
ME290130099Medicaid
ME4176840001Medicare NSC
MEMM4295Medicare PIN
ME180043475OtherRR MEDICARE