Smart Vision, LLC
Organization Active NPI Optometrist · Farmingdale, ME
NPI 1245309400 · NPPES record last updated Feb 9, 2017
Key facts
- NPI
- 1245309400
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT961 (ME)
- Legal business name
- SMART VISION, LLC
- Practice address
- 210 Maine Ave
Farmingdale, ME 04344-4515 - Phone
- (207) 582-5800
- Fax
- (207) 588-0743
- NPI assigned
- Nov 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Jessilin M Quint, O.D.
- Title
- President/Optometrist
- Phone
- (207) 582-5800
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 8
-
Sarah Jayne Gladstone, O.D.
-
Nicholas A Holden, O.D.
-
Lucie Neron, OD
-
Jessilin Quint, O.D.
-
Nicole C Shipp, O.D.
-
Ethan Ranger Taylor, O.D.
-
James S Brewer, O.D.
-
Anne L Tobyne, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180721000142 | ME | DME Supplier - Physician - Optometrist | 8022393230 | Practice locations: Farmingdale, ME |
National Provider Directory
- Tax ID family
- Smart Vision LLC
Locations
824 Stillwater Ave
Bangor, ME 04401
Phone (207) 942-1291
210 Maine Ave
Farmingdale, ME 04344
Phone (207) 582-5800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPT961 | ME | Yes |
| Eyewear Supplier | 332H00000X |
Addresses
Primary practice location
210 Maine Ave
Farmingdale, ME 04344-4515
Mailing address
210 Maine Ave
Farmingdale, ME 04344-4515
Phone (207) 582-5800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 125420100 | Medicaid | ME | |
| 39705 | Other | ME | DAVIS VISION |
Other providers in Farmingdale, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.