Healthcare Provider Details

I. General information

NPI: 1164737698
Provider Name (Legal Business Name): RACHEL M SUGAL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST
NORWAY ME
04268-5645
US

IV. Provider business mailing address

193 MAIN ST
NORWAY ME
04268-5645
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-0027
  • Fax: 207-743-0051
Mailing address:
  • Phone: 207-743-0027
  • Fax: 207-743-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT915
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: