Individual
ETHAN RANGER TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
824 STILLWATER AVENUE, BANGOR, ME 04401-3614
(207) 847-7554
Mailing address
824 STILLWATER AVENUE, BANGOR, ME 04401-3614
(207) 847-7554
(207) 945-0085
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3398
MN
152W00000X
Optometrist
Primary
OPT949
ME
Other
Enumeration date
09/20/2013
Last updated
08/20/2015
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