Provider Demographics
NPI:1174767578
Name:GIL POLIQUIN HEARING AID & OPTICAL CENTER, INC.
Entity type:Organization
Organization Name:GIL POLIQUIN HEARING AID & OPTICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLIQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-0333
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0290
Mailing Address - Country:US
Mailing Address - Phone:207-784-0333
Mailing Address - Fax:
Practice Address - Street 1:50 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7116
Practice Address - Country:US
Practice Address - Phone:207-784-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
MEDL43237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty