Active NPI
Mark A. Nickerson
- Optician
- Brunswick, ME
National Provider Identifier
1710181045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 13545
- Practice address
- 8 Mason St
Brunswick, ME 04011-1514 - Phone
- (207) 725-7741
- NPI assigned
- Jun 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 13545 | ME | Primary |
Addresses
Primary practice location
8 Mason St
Brunswick, ME 04011-1514
Mailing address
8 Mason Street
Brunswick, ME 04011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13545 | ME | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710181045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 MASON STREET",
"city": "BRUNSWICK",
"state": "ME",
"postal_code": "04011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 MASON ST",
"city": "BRUNSWICK",
"state": "ME",
"postal_code": "040111514",
"telephone_number": "207-725-7741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "MARK",
"middle_name": "A.",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "ME",
"license": "13545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brunswick, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.