Provider Demographics
NPI:1164555603
Name:JOSEPH V BARRESI ODPA
Entity Type:Organization
Organization Name:JOSEPH V BARRESI ODPA
Other - Org Name:BARRESI & MITCHELL OD'S
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-834-3124
Mailing Address - Street 1:12 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1231
Mailing Address - Country:US
Mailing Address - Phone:207-834-3124
Mailing Address - Fax:207-834-3127
Practice Address - Street 1:12 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1231
Practice Address - Country:US
Practice Address - Phone:207-834-3124
Practice Address - Fax:207-834-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109310000Medicaid
ME2022593OtherAETNA
ME8047994OtherCIGNA
A08007219OtherDMERC SUBMITTER NUMBER
ME024174OtherANTHEM
410046313OtherRR MEDICARE
ME109310000Medicaid
ME152607Medicare ID - Type UnspecifiedPROVIDER NUMBER
ME152607Medicare PIN