Provider Demographics
NPI:1073609129
Name:DRS. DUTCH & MARNECHECK,LLC
Entity Type:Organization
Organization Name:DRS. DUTCH & MARNECHECK,LLC
Other - Org Name:DRS. DUTCH & MARNECHECK, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-1480
Mailing Address - Street 1:94 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6344
Mailing Address - Country:US
Mailing Address - Phone:207-338-1480
Mailing Address - Fax:207-338-1498
Practice Address - Street 1:94 HIGH ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6344
Practice Address - Country:US
Practice Address - Phone:207-338-1480
Practice Address - Fax:207-338-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT576152W00000X
MEOPT795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134610000Medicaid
MEMM7987OtherPTAN#
MEP00313443OtherRMEDICARE
MEP00313443OtherRMEDICARE
ME134610000Medicaid