Healthcare Provider Details

I. General information

NPI: 1427364223
Provider Name (Legal Business Name): SARAH ELLIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH MCCRUM OD

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST
RUMFORD ME
04276-2060
US

IV. Provider business mailing address

56 FRANKLIN ST PO BOX 310
RUMFORD ME
04276-2060
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-4491
  • Fax: 207-364-4015
Mailing address:
  • Phone: 207-364-4491
  • Fax: 207-364-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number919
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: