Provider Demographics
NPI:1396047346
Name:LAURITSEN, STEPHEN LEROY (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEROY
Last Name:LAURITSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 US ROUTE 1
Mailing Address - Street 2:CARRIAGE HOUSE SQUARE
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1342
Mailing Address - Country:US
Mailing Address - Phone:207-781-7277
Mailing Address - Fax:207-781-7277
Practice Address - Street 1:204 US ROUTE 1
Practice Address - Street 2:CARRIAGE HOUSE SQUARE
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1342
Practice Address - Country:US
Practice Address - Phone:207-781-7277
Practice Address - Fax:207-781-7277
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist