NPIMap

Organization Active NPI

Smart Vision, LLC

  • Optometrist
  • Bangor, ME
National Provider Identifier
1811066079
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT961 Issued in ME
Legal business name
SMART VISION, LLC
Practice address
824 Stillwater Ave
Bangor, ME 04401-3614
Phone
(207) 947-7554
Fax
(207) 945-0085
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Jessilin M Quint, ODNPI 1841603867
Title
President/Optometrist
Phone
(207) 947-7554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT961 ME Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

824 Stillwater Ave
Bangor, ME 04401-3614

Mailing address

824 Stillwater Ave
Bangor, ME 04401-3614
Phone (207) 947-7554

Other identifiers 2

IdentifierTypeStateIssuer
44665OtherMEDAVIS VISION
125420101MedicaidME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180622001118 ME DME Supplier - Physician - Optometrist 8022393230 Practice locations: Bangor, ME

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Smart Vision, LLC824 Stillwater Ave, Bangor, ME 04401-3614(207) 947-7554 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Mar 10, 2017

National Provider Directory

National Provider Directory
Tax ID family
Smart Vision LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1811066079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013614",
            "telephone_number": "207-947-7554",
            "fax_number": "207-945-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013614",
            "telephone_number": "207-947-7554",
            "fax_number": "207-945-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMART VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "QUINT",
        "authorized_official_first_name": "JESSILIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OPTOMETRIST",
        "authorized_official_telephone_number": "207-947-7554",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT961",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "44665",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125420101",
            "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 Feb 9, 2017; 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.