Healthcare Provider Details

I. General information

NPI: 1104003938
Provider Name (Legal Business Name): N SCOTT FERGUSON O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 MAIN ST
FRYEBURG ME
04037-1118
US

IV. Provider business mailing address

479 MAIN ST
FRYEBURG ME
04037-1118
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-3307
  • Fax: 207-935-4002
Mailing address:
  • Phone: 207-935-3307
  • Fax: 207-935-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOPT699TA
License Number StateME

VIII. Authorized Official

Name: N SCOTT FERGUSON
Title or Position: OWNER
Credential: O.D.
Phone: 207-935-3307