Provider Demographics
NPI:1831279553
Name:DR ALAN J MATHIEU P.A.
Entity Type:Organization
Organization Name:DR ALAN J MATHIEU P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-839-2638
Mailing Address - Street 1:347 MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1338
Mailing Address - Country:US
Mailing Address - Phone:207-839-2638
Mailing Address - Fax:207-839-4204
Practice Address - Street 1:347 MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1338
Practice Address - Country:US
Practice Address - Phone:207-839-2638
Practice Address - Fax:207-839-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT724152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041364OtherAETNA
ME116900000Medicaid
MEM851OtherCIGNA
MEMT048OtherHARVARD PILGRAM
ME003725OtherANTHEM
ME003725OtherANTHEM
MEMT048OtherHARVARD PILGRAM
ME116900000Medicaid