Provider Demographics
NPI:1679044739
Name:ADVANCED CLINICAL EYECARE OF SOUTHERN MAINE, P.C.
Entity type:Organization
Organization Name:ADVANCED CLINICAL EYECARE OF SOUTHERN MAINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-771-7968
Mailing Address - Street 1:335 MAINE MALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3214
Mailing Address - Country:US
Mailing Address - Phone:207-771-7968
Mailing Address - Fax:207-771-7983
Practice Address - Street 1:335 MAINE MALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3214
Practice Address - Country:US
Practice Address - Phone:207-771-7968
Practice Address - Fax:207-771-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty