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General NPI Number Information
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NPI Number | 1861518870
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Entity Type | Individual
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Provider Name | CARL E GULLBRAND O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 63 MAIN ST STE B
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City | BUXTON
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State | ME
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Zip | 04093-6101
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Country | US
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Telephone | 207-929-3007
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Fax | 207-929-3595
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | BAR MILLS
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State | ME
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Zip | 04004-0629
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Country | US
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Telephone | 207-929-3007
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Fax | 207-929-3007
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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 | OPT 752
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License Number State | ME
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