Provider Demographics
NPI:1063136489
Name:BACAS, CONSTANTINOS JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINOS
Middle Name:JOHN
Last Name:BACAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2338
Mailing Address - Country:US
Mailing Address - Phone:973-377-1060
Mailing Address - Fax:973-660-1133
Practice Address - Street 1:311 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2338
Practice Address - Country:US
Practice Address - Phone:973-377-1060
Practice Address - Fax:973-660-1133
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00717200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist