Northeast Retina Associates, PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

013866 Issued in ME

Legal business name

NORTHEAST RETINA ASSOCIATES, PA

Practice address

272 Cottage St
Sanford, ME 04073-1815

Phone

(207) 324-3380

Fax

(207) 636-5023

NPI assigned

Dec 28, 2005

Organization subpart

No

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

Authorized official

Name

Jennifer Brearey

Title

Ophthalmic Manager

Phone

(207) 324-3380

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124005590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 COTTAGE ST",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "040731815",
            "telephone_number": "207-324-3380",
            "fax_number": "207-636-5023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 COTTAGE ST",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "040731815",
            "telephone_number": "207-324-3380",
            "fax_number": "207-636-5023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST RETINA ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BREAREY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OPHTHALMIC MANAGER",
        "authorized_official_telephone_number": "207-324-3380"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "ME",
            "license": "013866",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "NH",
            "license": "9375",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Mousette, DPT
• Mukesh Bhargava, M. D. LLC
• Susan Mulkern, APRN
• Megan Myers, MOT
• Kimberly A Nevells, FNP-BC
• Terry Wayne Norton, RN
• Erin Noyes
• Jaime O'Brien
• Jennifer Marie O'Connor, PMHNP
• Jodie Ann O'Keefe-Adawadkar, LICSW

• Ophthalmology Physician in Sanford, ME
• Providers in Sanford, ME by specialty
• Ophthalmology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.