NPIMap

Organization Active NPI

Casco Bay Eyecare LLC

  • Optometrist
  • South Portland, ME
National Provider Identifier
1063401693
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CASCO BAY EYECARE LLC
Practice address
144 Thadeus St
South Portland, ME 04106-6259
Phone
(207) 885-8686
Fax
(207) 883-7154
NPI assigned
Oct 17, 2005
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Rebecca Darling
Title
Group Administrator
Phone
(207) 885-8686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

144 Thadeus St
South Portland, ME 04106-6259

Mailing address

PO Box 7487
Portland, ME 04112-7487
Phone (207) 885-8686

Other identifiers 5

IdentifierTypeStateIssuer
154790000MedicaidME
154790001MedicaidME
154790003MedicaidME
154790002MedicaidME
154790004MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071102000479 ME Part B Supplier - Clinic/Group Practice 3274620562 Receives reassigned benefits from 9 practitioners
Practice locations: Falmouth, ME; Portland, ME; Scarborough, ME; South Portland, ME

National Provider Directory

National Provider Directory

Locations

127 Pleasant Hill Rd
Scarborough, ME 04074

144 Thadeus St
South Portland, ME 04106
Phone (207) 885-8686

10 Q St
South Portland, ME 04106
Phone (207) 773-2020

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1063401693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7487",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041127487",
            "telephone_number": "207-885-8686",
            "fax_number": "207-883-7154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 THADEUS ST",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066259",
            "telephone_number": "207-885-8686",
            "fax_number": "207-883-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASCO BAY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "DARLING",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "GROUP ADMINISTRATOR",
        "authorized_official_telephone_number": "207-885-8686",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154790000",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154790001",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154790003",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154790002",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154790004",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.