Provider Demographics
NPI:1912900309
Name:PARADIS, PETER DOUGLAS (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DOUGLAS
Last Name:PARADIS
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 1:216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6116
Mailing Address - Country:US
Mailing Address - Phone:207-872-2797
Mailing Address - Fax:207-872-2793
Practice Address - Street 1:216 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6116
Practice Address - Country:US
Practice Address - Phone:207-872-2797
Practice Address - Fax:207-872-2793
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME249080099Medicaid
MEMN2200OtherHARVARD PILGRIM
ME025801OtherANTHEM BCBS
MEM24029OtherCIGNA
ME2023127OtherAETNA
MEM24029OtherCIGNA
ME249080099Medicaid