MEDICARE: JOHN A. DUBOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	OPT836	ME

General Provider Information

NPI Number	:	1154509867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A. DUBOIS

Provider Business Mailing Address
First Line	:	PO BOX 18
Second Line	:
City	:	CORNISH
State	:	ME
Zip	:	04020-0018
Country	:	US
Telephone Number	:	207-625-3700
Fax Number	:	207-625-3277

Provider Business Practice Location Address
First Line	:	95 MAPLE ST
Second Line	:
City	:	CORNISH
State	:	ME
Zip	:	04020-3101
Country	:	US
Telephone Number	:	207-625-3700
Fax Number	:	207-625-3277

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN A DUBOIS
Credential	:	O.D.
Telephone Number	:	207-625-3700

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	01/20/2009

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