Provider Demographics
NPI:1285829333
Name:GLADSTONE, SARAH JAYNE (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JAYNE
Last Name:GLADSTONE
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 1:824 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3614
Mailing Address - Country:US
Mailing Address - Phone:207-947-7554
Mailing Address - Fax:207-945-0085
Practice Address - Street 1:824 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3614
Practice Address - Country:US
Practice Address - Phone:207-947-7554
Practice Address - Fax:207-945-0085
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist