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General NPI Number Information
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NPI Number | 1063136489
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Entity Type | Individual
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Provider Name | CONSTANTINOS JOHN BACAS OD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 106B E MAIN ST
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City | MENDHAM
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State | NJ
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Zip | 07945-1544
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Country | US
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Telephone | 862-222-3800
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Fax | 862-832-3713
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Provider Business Mailing Address
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Address Line | 106B E MAIN ST
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City | MENDHAM
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State | NJ
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Zip | 07945-1544
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Country | US
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Telephone | 862-222-3800
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Fax | 862-832-3713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 27OA00717200
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License Number State | NJ
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