NPIMap

Organization Active NPI

Eye Center Northeast

  • Ophthalmology Physician
  • Bangor, ME
National Provider Identifier
1174603872
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE CENTER NORTHEAST
Practice address
417 State St
Suite 230
Bangor, ME 04401-6620
Phone
(207) 947-1291
Fax
(207) 947-9241
NPI assigned
Oct 17, 2006
Last updated
Jun 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Authorized official

Name
Mr. Reginald R Arnold Jr.
Title
Practice Administrator
Phone
(207) 947-1291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

417 State St
Suite 230
Bangor, ME 04401-6620

Mailing address

417 State St
Suite 230
Bangor, ME 04401-6620
Phone (207) 947-1291

Other identifiers 3

IdentifierTypeStateIssuer
1042060OtherAETNA
114630000MedicaidME
114630100MedicaidME

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1174603872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 STATE ST",
            "address_2": "SUITE 230",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016620",
            "telephone_number": "207-947-1291",
            "fax_number": "207-947-9241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 STATE ST",
            "address_2": "SUITE 230",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016620",
            "telephone_number": "207-947-1291",
            "fax_number": "207-947-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CENTER NORTHEAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "ARNOLD",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "207-947-1291",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1042060",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114630000",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114630100",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.