1104065994 NPI number — NATHAN H DRUM, OD

Table of content: (NPI 1104065994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104065994 NPI number — NATHAN H DRUM, OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATHAN H DRUM, OD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104065994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 527
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03584-3072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-788-2031
Provider Business Mailing Address Fax Number:
603-788-2508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
COLEBROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03576-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-237-4500
Provider Business Practice Location Address Fax Number:
603-237-9900
Provider Enumeration Date:
02/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DRUM
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
603-788-2031

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0300000272 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 552 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30010684 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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