Provider Demographics
NPI:1124364765
Name:MARK E. ELKINSON, OD, PA
Entity Type:Organization
Organization Name:MARK E. ELKINSON, OD, PA
Other - Org Name:MAINE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-761-9054
Mailing Address - Street 1:200 GORHAM RD
Mailing Address - Street 2:SUITE 940
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2409
Mailing Address - Country:US
Mailing Address - Phone:207-761-9054
Mailing Address - Fax:
Practice Address - Street 1:200 GORHAM RD
Practice Address - Street 2:SUITE 940
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2409
Practice Address - Country:US
Practice Address - Phone:207-761-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-01
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1112900001Medicare NSC
ME0034629Medicare PIN