Provider Demographics
NPI:1336297704
Name:PIRONE, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:PIRONE
Suffix:
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 1:595 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2322
Mailing Address - Country:US
Mailing Address - Phone:207-210-6700
Mailing Address - Fax:207-899-3239
Practice Address - Street 1:595 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2322
Practice Address - Country:US
Practice Address - Phone:207-210-6700
Practice Address - Fax:207-899-3239
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME OPT 883152W00000X
GAGA 1778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061451OtherANTHEM
ME8586932OtherCIGNA
MEMNT036OtherHARVARD PILGRIM
ME431970499Medicaid
ME431970499Medicaid
MEME1585Medicare PIN