Individual
DR. ROGER L BRIGNULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
82 WATER ST, ELLSWORTH, ME 04605-2006
(207) 667-8615
(207) 667-4212
Mailing address
82 WATER ST, ELLSWORTH, ME 04605-2006
(207) 667-8615
(207) 667-4212
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT551
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010947
BLUE CROSS
ME
05
—
223460099
—
ME
01
—
705688
MEDICARE
—
Enumeration date
08/10/2006
Last updated
01/18/2012
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