Provider Demographics
NPI:1972836518
Name:SPRAGUE, JENNIFER LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:ROBICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:35 STATE HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-8816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 STATE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-8816
Practice Address - Country:US
Practice Address - Phone:207-561-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOFC38152W00000X
PAOEG002198152W00000X
MEOPT913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist