Provider Demographics
NPI:1861547937
Name:METAYER, MICHAEL A (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:METAYER
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 1:550 CENTER ST STE 9040
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6333
Mailing Address - Country:US
Mailing Address - Phone:207-782-5030
Mailing Address - Fax:207-777-1179
Practice Address - Street 1:550 CENTER ST STE 9040
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6333
Practice Address - Country:US
Practice Address - Phone:207-782-5030
Practice Address - Fax:207-777-1179
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2362948OtherAETNA
ME1822233742OtherCIGNA HEALTHCARE
ME025245OtherBCBS
MET31332Medicare UPIN
MEMM0608Medicare ID - Type Unspecified