Provider Demographics
NPI:1861518870
Name:GULLBRAND, CARL E (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:GULLBRAND
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:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0629
Mailing Address - Country:US
Mailing Address - Phone:207-929-3007
Mailing Address - Fax:207-929-3007
Practice Address - Street 1:63 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6101
Practice Address - Country:US
Practice Address - Phone:207-929-3007
Practice Address - Fax:207-929-3595
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT 752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEUX6716OtherMEDICARE PTAN
MEU16411Medicare UPIN
MEME1278Medicare PIN