Provider Demographics
NPI:1962458505
Name:MAILHOT, REGINALD (OD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:
Last Name:MAILHOT
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 1:220 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6347
Mailing Address - Country:US
Mailing Address - Phone:207-782-9501
Mailing Address - Fax:
Practice Address - Street 1:220 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6347
Practice Address - Country:US
Practice Address - Phone:207-782-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM52420OtherCIGNA HEALTHSOURCE #
ME105560000Medicaid
ME000023OtherANTHEM ID #
MEMM298301Medicare PIN
MEP00370820Medicare PIN
ME000023OtherANTHEM ID #