1538356167 NPI number — EYEGLASS SHOP, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538356167 NPI number — EYEGLASS SHOP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYEGLASS SHOP, PLLC
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:
1538356167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03802-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-436-4509
Provider Business Mailing Address Fax Number:
603-431-5367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 DANIEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-436-4509
Provider Business Practice Location Address Fax Number:
603-431-5367
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-436-4509

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  575 , 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: 1051349 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1538356167 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1538356167 . This is a "VISION SEVICE PLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0904169Y0NH01 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 9925868 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1538356167 . This is a "EBPA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1538356167 . This is a "TRI CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 27079 . This is a "AVESIS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30003757 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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