NPIMap

Organization Active NPI

Penobscot Eye Care PA

  • Optometrist
  • Brewer, ME
National Provider Identifier
1073554853
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PENOBSCOT EYE CARE PA
Practice address
29 Dirigo Drive
Brewer, ME 04412-1600
Phone
(207) 942-2015
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Authorized official

Name
Kimberly D. AllenNPI 1659479624
Title
Sec / Tres
Phone
(207) 942-2015

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

29 Dirigo Drive
Brewer, ME 04412-1600

Mailing address

29 Dirigo Drive
Brewer, ME 04412-1600
Phone (207) 942-2015

Other identifiers 1

IdentifierTypeStateIssuer
119630001MedicaidME

Other names 1

  • Penobscot Eye Care INC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000284 ME Part B Supplier - Clinic/Group Practice 5597737692 Receives reassigned benefits from 5 practitioners
Practice locations: Brewer, ME

National Provider Directory

National Provider Directory

Locations

51 Washington St
Ste A
Bangor, ME 04401
Phone (207) 942-1142

29 Dirigo Dr
Brewer, ME 04412
Phone (207) 942-2015

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1073554853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 DIRIGO DRIVE",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121600",
            "telephone_number": "207-942-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 DIRIGO DRIVE",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121600",
            "telephone_number": "207-942-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT EYE CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "SEC / TRES",
        "authorized_official_telephone_number": "207-942-2015"
    },
    "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": "119630001",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penobscot Eye Care INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Brewer, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.