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 1:136 MILL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668-3344
Mailing Address - Country:US
Mailing Address - Phone:207-796-5033
Mailing Address - Fax:207-796-5528
Practice Address - Street 1:136 MILL ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668-3344
Practice Address - Country:US
Practice Address - Phone:207-796-5033
Practice Address - Fax:207-796-5528
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2025-08-27
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
043000239001OtherFEDERAL BLUE CROSS
1042751OtherAETNA US HEALTHCARE
ME151320000Medicaid
029141OtherANTHEM BLUE CROSS
000582597002OtherUNITED HEALTH CARE
ME410006235OtherPALMETTO GBA--RAILROAD
MNT287OtherHARVARD PILGRIM HEALTH
ME410006235OtherPALMETTO GBA--RAILROAD
000582597002OtherUNITED HEALTH CARE
MET31379Medicare UPIN