Provider Demographics
NPI:1528141348
Name:FARRELL, GREGORY MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:FARRELL
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 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:075-383-7002
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:53 TRANSALPINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4223
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000582597002OtherUNITED HEALTH CARE
ME410006235OtherPALMETTO GBA--RAILROAD
029141OtherANTHEM BLUE CROSS
MNT287OtherHARVARD PILGRIM HEALTH
1042751OtherAETNA US HEALTHCARE
043000239001OtherFEDERAL BLUE CROSS
ME151320000Medicaid
ME410006235OtherPALMETTO GBA--RAILROAD
000582597002OtherUNITED HEALTH CARE
MET31379Medicare UPIN