Provider Demographics
NPI:1457367419
Name:MATHIEU, ALAN JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:MATHIEU
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 1:347 MAIN ST STE D
Mailing Address - Street 2:
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 STE D
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT724152W00000X
GAOPT001081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003725OtherBC/BS ANTHEN
ME1041364OtherAETNA
MEM851OtherCIGNA
ME116900000Medicaid
MEMT048OtherHARVARD PILGRIM HEALTH CA
ME003725OtherBC/BS ANTHEN
MET31322Medicare UPIN