Provider Demographics
NPI:1346281128
Name:SAWYER, RANDOLPH B (OD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:B
Last Name:SAWYER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MOUNT AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8651
Mailing Address - Country:US
Mailing Address - Phone:207-753-0800
Mailing Address - Fax:
Practice Address - Street 1:100 MOUNT AUBURN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8651
Practice Address - Country:US
Practice Address - Phone:207-753-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME872T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU99981Medicare UPIN
MEMM0351Medicare ID - Type Unspecified