Provider Demographics
NPI:1487898508
Name:MORSE, ELIZABETH A (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:MORSE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:272 STATE STREET
Mailing Address - Street 2:OPTICAL OUTLET, LLC
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-992-9172
Mailing Address - Fax:207-992-2401
Practice Address - Street 1:272 STATE STREET
Practice Address - Street 2:OPTICAL OUTLET, LLC
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-992-9172
Practice Address - Fax:207-992-2401
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECERTIFICATE #157491156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433093600Medicaid