Provider Demographics
NPI:1356483846
Name:GAETANI EYE CARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:GAETANI EYE CARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAETANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-827-2616
Mailing Address - Street 1:614 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-2120
Mailing Address - Country:US
Mailing Address - Phone:207-827-2616
Mailing Address - Fax:
Practice Address - Street 1:614 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2120
Practice Address - Country:US
Practice Address - Phone:207-827-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2058619OtherAETNA ID NUMBER
ME2058619OtherAETNA ID NUMBER
ME0130760001Medicare NSC
MEMM7615Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER
MEMM2568Medicare PIN