Provider Demographics
NPI:1609967470
Name:METAYER, ROXANNE PARKER (OD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:PARKER
Last Name:METAYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COMMONS AVE # B
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5554
Mailing Address - Country:US
Mailing Address - Phone:207-892-2273
Mailing Address - Fax:207-892-2275
Practice Address - Street 1:4 COMMONS AVE # B
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5554
Practice Address - Country:US
Practice Address - Phone:207-892-2273
Practice Address - Fax:207-892-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31333Medicare UPIN
MAMM0609Medicare ID - Type Unspecified