Organization Active NPI

Brunswick Eye Care Associates, PA

  • Optometrist
  • Brunswick, ME
National Provider Identifier
1467533588
Registry record updated Apr 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT661
Legal business name
BRUNSWICK EYE CARE ASSOCIATES, PA
Practice address
331 Maine St
Suite 1
Brunswick, ME 04011-3358
Phone
(207) 725-2161
Fax
(207) 725-9189
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2011

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

Authorized official

Name
Brian L Daniels, O.D.
Title
President
Phone
(207) 725-2161

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT661 Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT618 ME
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT787
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 011131 ME

Addresses

Primary practice location

331 Maine St
Suite 1
Brunswick, ME 04011-3358

Mailing address

331 Maine St
Suite 1
Brunswick, ME 04011-3358
Phone (207) 725-2161

Other identifiers 1

IdentifierTypeStateIssuer
111880000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050131000206 ME Part B Supplier - Clinic/Group Practice 6002866753 Receives reassigned benefits from 4 practitioners
Practice locations: Brunswick, ME

National Provider Directory

National Provider Directory

Locations

331 Maine St
Ste 1
Brunswick, ME 04011
Phone (207) 725-2161

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1303776000000",
    "number": "1467533588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 MAINE ST",
            "address_2": "SUITE 1",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040113358",
            "telephone_number": "207-725-2161",
            "fax_number": "207-725-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 MAINE ST",
            "address_2": "SUITE 1",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040113358",
            "telephone_number": "207-725-2161",
            "fax_number": "207-725-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNSWICK EYE CARE ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-725-2161",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "OPT661",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT618",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "OPT787",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "ME",
            "license": "011131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111880000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.