Organization Active NPI

Nathan Corbell, PHD, OD, Inc

  • Optometrist
  • Scarborough, ME
National Provider Identifier
1891053005
Registry record updated May 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT907 Issued in ME
Legal business name
NATHAN CORBELL, PHD, OD, INC
Practice address
25 Hannaford Dr.
Scarborough, ME 04074-9057
Phone
(207) 396-6603
Fax
(207) 396-6604
NPI assigned
Apr 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name
Dr. Nathan Corbell, O.D.NPI 1215133541
Title
Owner
Phone
(207) 396-6603

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT907 ME Primary

Addresses

Primary practice location

25 Hannaford Dr.
Scarborough, ME 04074-9057

Mailing address

25 Hannaford Dr.
Scarborough, ME 04074-9057
Phone (207) 396-6603

Other identifiers 2

IdentifierTypeStateIssuer
000958602OtherMEMEDICARE
1215133541MedicaidME

Other names 1

  • Seacoast Vision Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120809000020 ME Part B Supplier - Clinic/Group Practice 9931355856 Receives reassigned benefits from 1 practitioner
Practice locations: Scarborough, ME

National Provider Directory

National Provider Directory

Locations

25 Hannaford Dr
Scarborough, ME 04074
Phone (207) 396-6603

Practitioners & affiliated clinicians

Practitioners 1

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": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1891053005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HANNAFORD DR.",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749057",
            "telephone_number": "207-396-6603",
            "fax_number": "207-396-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HANNAFORD DR.",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749057",
            "telephone_number": "207-396-6603",
            "fax_number": "207-396-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATHAN CORBELL, PHD, OD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "CORBELL",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-396-6603",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000958602",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215133541",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seacoast Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scarborough, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; 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.