Provider Demographics
NPI:1730370420
Name:MACINNES, JOHN STANTON (OPTICIAN CERTIFIED)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STANTON
Last Name:MACINNES
Suffix:
Gender:M
Credentials:OPTICIAN CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 UNION STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3082
Mailing Address - Country:US
Mailing Address - Phone:207-942-0332
Mailing Address - Fax:207-942-0332
Practice Address - Street 1:885 UNION STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3082
Practice Address - Country:US
Practice Address - Phone:207-942-0332
Practice Address - Fax:207-942-0332
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10328156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0902110001Medicare PIN