Provider Demographics
NPI:1427364223
Name:ELLIS, SARAH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MCCRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2060
Mailing Address - Country:US
Mailing Address - Phone:207-364-4491
Mailing Address - Fax:207-364-4015
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2060
Practice Address - Country:US
Practice Address - Phone:207-364-4491
Practice Address - Fax:207-364-4015
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME919152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist