Provider Demographics
NPI:1730147612
Name:CAPINO, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CAPINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1230 BRIDGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1261
Mailing Address - Country:US
Mailing Address - Phone:978-452-2100
Mailing Address - Fax:978-446-0490
Practice Address - Street 1:1230 BRIDGE ST
Practice Address - Street 2:MERRIMACK EYE CLINIC
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850
Practice Address - Country:US
Practice Address - Phone:978-452-2100
Practice Address - Fax:978-446-0490
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57517207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3055914Medicaid
E32397Medicare UPIN
MA3055914Medicaid