Provider Demographics
NPI:1174964449
Name:COSTELLO, ARIELLE L (OD)
Entity type:Individual
Prefix:DR
First Name:ARIELLE
Middle Name:L
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 MOOSEHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4054
Mailing Address - Country:US
Mailing Address - Phone:631-834-7588
Mailing Address - Fax:207-368-2002
Practice Address - Street 1:419 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4054
Practice Address - Country:US
Practice Address - Phone:207-355-3333
Practice Address - Fax:207-368-2002
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist