Provider Demographics
NPI:1689704025
Name:HALLOWELL & MACMANNIS, O.D., P.A.
Entity Type:Organization
Organization Name:HALLOWELL & MACMANNIS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALLOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-454-2277
Mailing Address - Street 1:4 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1609
Mailing Address - Country:US
Mailing Address - Phone:207-454-2277
Mailing Address - Fax:207-454-2910
Practice Address - Street 1:4 PARK ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1609
Practice Address - Country:US
Practice Address - Phone:207-454-2277
Practice Address - Fax:207-454-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME567TA152W00000X
ME667TA152W00000X
MEOPT900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126350000Medicaid
MET31707Medicare UPIN
MEMM4149Medicare PIN
MET31705Medicare UPIN
ME0238860002Medicare NSC