Provider Demographics
NPI:1295742989
Name:MACMANNIS, ROBERT A (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MACMANNIS
Suffix:
Gender:M
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:PO BOX 405
Mailing Address - Street 2:4 PARK ST
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0405
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:04619-0405
Practice Address - Country:US
Practice Address - Phone:207-454-2277
Practice Address - Fax:207-454-2910
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME667TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126350000Medicaid
MEPX4167Medicare PIN
T31707Medicare UPIN
ME126350000Medicaid
MEPX4166Medicare PIN