Provider Demographics
NPI:1104911908
Name:MARNECHECK, AMY M (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:MARNECHECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:MARNECHECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:O,D
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0209
Mailing Address - Country:US
Mailing Address - Phone:207-338-1480
Mailing Address - Fax:207-338-1498
Practice Address - Street 1:91 WALDO AVENUE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915
Practice Address - Country:US
Practice Address - Phone:207-338-1480
Practice Address - Fax:207-338-1498
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7987OtherPTAN#
ME308220099Medicaid
MEMM6126Medicare UPIN