Provider Demographics
NPI:1447432570
Name:KULL, SEAN R (OD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:KULL
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 1:2 SYLVAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3697
Mailing Address - Country:US
Mailing Address - Phone:207-827-4802
Mailing Address - Fax:207-827-4545
Practice Address - Street 1:2 SYLVAN ROAD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3697
Practice Address - Country:US
Practice Address - Phone:207-827-4802
Practice Address - Fax:207-827-4545
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7695Medicare PIN
ME1273560001Medicare NSC
MEU74374Medicare UPIN