Provider Demographics
NPI:1649452293
Name:MICHAEL E. MARDEN, O.D.
Entity type:Organization
Organization Name:MICHAEL E. MARDEN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-236-8879
Mailing Address - Street 1:377 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4403
Mailing Address - Country:US
Mailing Address - Phone:207-236-8879
Mailing Address - Fax:207-236-3885
Practice Address - Street 1:377 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4403
Practice Address - Country:US
Practice Address - Phone:207-236-8879
Practice Address - Fax:207-236-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0238750001Medicare NSC
MM3923Medicare PIN