Provider Demographics
NPI:1053488221
Name:PAKULSKI, DAVID A (OD, PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PAKULSKI
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0608
Mailing Address - Country:US
Mailing Address - Phone:207-474-9613
Mailing Address - Fax:207-474-0849
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1852
Practice Address - Country:US
Practice Address - Phone:207-474-9613
Practice Address - Fax:207-474-0849
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME671TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME122670000Medicaid
ME0161280001Medicare NSC