Provider Demographics
NPI:1396979696
Name:AUBURN MALL EYECARE
Entity type:Organization
Organization Name:AUBURN MALL EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:METAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-782-5030
Mailing Address - Street 1:550 CENTER ST
Mailing Address - Street 2:BOX 9040
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6305
Mailing Address - Country:US
Mailing Address - Phone:207-782-5030
Mailing Address - Fax:207-777-1179
Practice Address - Street 1:550 CENTER ST
Practice Address - Street 2:BOX 9040
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6305
Practice Address - Country:US
Practice Address - Phone:207-782-5030
Practice Address - Fax:207-777-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208820000Medicaid
MET31332Medicare UPIN
ME208820000Medicaid