Provider Demographics
NPI:1881866085
Name:MACINNES OPTICAL
Entity Type:Organization
Organization Name:MACINNES OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN CERTIFIED
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:MACINNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-942-0332
Mailing Address - Street 1:885 UNION ST
Mailing Address - Street 2:STE 140
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3082
Mailing Address - Country:US
Mailing Address - Phone:207-942-0332
Mailing Address - Fax:207-942-0332
Practice Address - Street 1:885 UNION ST
Practice Address - Street 2:STE 140
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3082
Practice Address - Country:US
Practice Address - Phone:207-942-0332
Practice Address - Fax:207-942-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10328156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0902110001Medicare NSC