Healthcare Provider Details

I. General information

NPI: 1063136489
Provider Name (Legal Business Name): CONSTANTINOS JOHN BACAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106B E MAIN ST
MENDHAM NJ
07945-1544
US

IV. Provider business mailing address

106B E MAIN ST
MENDHAM NJ
07945-1544
US

V. Phone/Fax

Practice location:
  • Phone: 862-222-3800
  • Fax: 862-832-3713
Mailing address:
  • Phone: 862-222-3800
  • Fax: 862-832-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00717200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: