Provider Demographics
NPI:1700897188
Name:BRIGNULL, ROGER L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:BRIGNULL
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 1:82 WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2006
Mailing Address - Country:US
Mailing Address - Phone:207-667-8615
Mailing Address - Fax:207-667-4212
Practice Address - Street 1:82 WATER ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2006
Practice Address - Country:US
Practice Address - Phone:207-667-8615
Practice Address - Fax:207-667-4212
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010947OtherBLUE CROSS
ME223460099Medicaid
705688OtherMEDICARE
ME223460099Medicaid
705688OtherMEDICARE