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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN F MCCANN OD (OWNER)
(207) 667-9093
Entity
Organization

Contact information

Practice address
248 STATE ST., STE. 7, ELLSWORTH, ME 04605
(207) 667-9093
(207) 664-0420
Mailing address
248 STATE ST., STE. 7, ELLSWORTH, ME 04605
(207) 667-9093
(207) 664-0420

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03839500
ME
01
706124
MEDICARE PTAN
ME
Enumeration date
12/05/2014
Last updated
12/05/2014
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