Eyecare Medical Group Optical Shop

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

EYECARE MEDICAL GROUP OPTICAL SHOP

Practice address

53 Sewall Street
Portland, ME 04102

Phone

(207) 828-2020

Fax

(207) 773-7034

NPI assigned

Sep 14, 2006

Organization subpart

No

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

Authorized official

Name

Lynn Shorty, RN, CMPE

Title

Chief Operating Offier

Phone

(207) 791-8234

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Eyecare Medical Group

  • Ophthalmology Physician
  • Portland, ME
  • NPI 1467557280

  O20100930079537

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1184729915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 SEWALL STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-773-9597",
            "fax_number": "207-773-7034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 SEWALL STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-828-2020",
            "fax_number": "207-773-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE MEDICAL GROUP OPTICAL SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "SHORTY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFIER",
        "authorized_official_telephone_number": "207-791-8234",
        "authorized_official_credential": "RN, CMPE"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109280300",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carole Ewald, LCSW
• Marissa Exchange
• Eyecare Medical Group
• Eyecare Medical Group
• Eyecare Medical Group
• Eyecare Today, PA
• Eyes on Rosemont LLC
• Eyes on Rosemont LLC
• Christine Adaora Ezeigwe
• Danielle M Ezekiel, MHRT/C

• Eyewear Supplier in Portland, ME
• Providers in Portland, ME by specialty
• Eyewear Supplier in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.