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General NPI Number Information
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NPI Number | 1033233655
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Entity Type | Organization
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Legal Business Name | HALLOWELL & MACMANNIS, O.D., P.A.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 19 COURT ST
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City | MACHIAS
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State | ME
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Zip | 04654-2108
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Country | US
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Telephone | 207-255-4461
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Fax | 207-255-8609
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | MACHIAS
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State | ME
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Zip | 04654-0477
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Country | US
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Telephone | 207-255-4461
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Fax | 207-255-8609
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN E. HALLOWELL
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Credential | O.D.
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Telephone | 207-255-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 567TA
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT900
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 667TA
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License Number State | ME
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