Provider Demographics
NPI:1174592919
Name:FERGUSON, NORMAN KENNETH III (OD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:KENNETH
Last Name:FERGUSON
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:N
Other - Middle Name:SCOTT
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:479 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037-1118
Mailing Address - Country:US
Mailing Address - Phone:207-935-3307
Mailing Address - Fax:207-935-4002
Practice Address - Street 1:479 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1118
Practice Address - Country:US
Practice Address - Phone:207-935-3307
Practice Address - Fax:207-935-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT699TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH09Y002162ME01OtherANTHEM BXBS
010448803001OtherCIGNA
015125OtherBXBS
699TAOtherCBA
015125OtherBXBS
MM2711Medicare PIN
0609870001Medicare NSC