Provider Demographics
NPI:1114174950
Name:SAWYER, ANGELIQUE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 WHITE MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5155
Mailing Address - Country:US
Mailing Address - Phone:603-356-3000
Mailing Address - Fax:603-356-4101
Practice Address - Street 1:1319 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5155
Practice Address - Country:US
Practice Address - Phone:603-356-3000
Practice Address - Fax:603-356-4101
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078850Medicaid
NH3078850Medicaid