1336385087 NPI number — MERRIMACK EYE CARE, LLC

Table of content: (NPI 1336385087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336385087 NPI number — MERRIMACK EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRIMACK EYE CARE, LLC
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:
1336385087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 FOX RUN RD
Provider Second Line Business Mailing Address:
SUITE 62
Provider Business Mailing Address City Name:
NEWINGTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-427-0022
Provider Business Mailing Address Fax Number:
603-430-2053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 FOX RUN RD
Provider Second Line Business Practice Location Address:
SUITE 62
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-427-0022
Provider Business Practice Location Address Fax Number:
603-430-2053
Provider Enumeration Date:
12/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AFSHAR
Authorized Official First Name:
SURAJ
Authorized Official Middle Name:
SADEGHI
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
603-427-0022

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0821 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 4714 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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