Bangor Eye Surgery, PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

BANGOR EYE SURGERY, PA

Practice address

900-A Hammond Street
Bangor, ME 04401

Phone

(207) 947-6743

Fax

(207) 945-4397

NPI assigned

Oct 26, 2015

Last updated

Oct 26, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Garth Allen Wilbanks, MDNPI 1265420640

Title

Treusurer

Phone

(207) 947-6743

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Listed as

Bangor Eye Surgery PACCN 20C0001021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 4

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.

• Garth Allen Wilbanks, MD

  • Ophthalmology Physician
  • Bangor, ME
  • NPI 1265420640
  Medicare reassignment NPD Authorized official
• Jeffrey Jay Jordan, MD

  • Ophthalmology Physician
  • Bangor, ME
  • NPI 1861480246
  Medicare reassignment NPD
• Marina Peskina, MD

  • Ophthalmology Physician
  • Bangor, ME
  • NPI 1487113486
  Medicare reassignment NPD
• Cynthia Amanda Self, MD

  • Ophthalmology Physician
  • Bangor, ME
  • NPI 1275521650
  Medicare reassignment NPD

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1215309653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900-A HAMMOND STREET",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-947-6743",
            "fax_number": "207-945-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900-A HAMMOND STREET",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-947-6743",
            "fax_number": "207-945-4397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANGOR EYE SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "WILBANKS",
        "authorized_official_first_name": "GARTH",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "TREUSURER",
        "authorized_official_telephone_number": "207-947-6743",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bangor Area Homeless Shelter
• Bangor Audiology PC
• Bangor Braces PC
• Bangor Denture
• Bangor Detox and Recovery
• Bangor Family Counseling Inc
• Bangor Family Dentistry
• Bangor Family Health Care
• Bangor Healthcare
• Bangor Mall Eye Association

• Ambulatory Surgical Clinic/Center in Bangor, ME
• Providers in Bangor, ME by specialty
• Ambulatory Surgical Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.