Provider Demographics
NPI:1073518502
Name:TAYLOR, GEORGE M JR (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1209
Mailing Address - Country:US
Mailing Address - Phone:207-454-2255
Mailing Address - Fax:207-454-3256
Practice Address - Street 1:330 NORTH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1209
Practice Address - Country:US
Practice Address - Phone:207-454-2255
Practice Address - Fax:207-454-3256
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME140840000Medicaid
ME020400758OtherTRICARE NORTH
ME410039523OtherRAILROAD MEDICARE
ME140840000Medicaid
ME020400758OtherTRICARE NORTH
ME0547210001Medicare NSC