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General NPI Number Information
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NPI Number | 1609841360
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Entity Type | Individual
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Provider Name | SAMMY L PELLETIER OD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 764 ROUTE ONE UNIT 6
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City | YORK
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State | ME
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Zip | 03909-5879
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Country | US
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Telephone | 207-363-7555
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Fax | 207-363-1711
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Provider Business Mailing Address
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Address Line | 764 ROUTE ONE UNIT 6
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City | YORK
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State | ME
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Zip | 03909-5879
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Country | US
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Telephone | 207-363-7555
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Fax | 207-363-1711
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT729
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License Number State | ME
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