Provider Demographics
NPI:1447504410
Name:RTFEC PC
Entity type:Organization
Organization Name:RTFEC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-356-2925
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:136 MAIN STREET
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-0827
Mailing Address - Country:US
Mailing Address - Phone:207-469-3211
Mailing Address - Fax:207-469-3911
Practice Address - Street 1:136 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-0827
Practice Address - Country:US
Practice Address - Phone:207-469-3211
Practice Address - Fax:207-469-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125310099Medicaid
ME0030746Medicare PIN
MEU03008Medicare UPIN
ME0919450002Medicare NSC