MEDICARE: MR. GARY C CHRISTIE OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	581	NH

General Provider Information

NPI Number	:	1235123670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY C CHRISTIE OPTICIAN

Provider Business Mailing Address
First Line	:	2 PILLSBURY ST STE 100
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-3502
Country	:	US
Telephone Number	:	603-228-1104
Fax Number	:	603-228-7061

Provider Business Practice Location Address
First Line	:	2 PILLSBURY ST STE 100
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-3502
Country	:	US
Telephone Number	:	603-228-1104
Fax Number	:	603-228-7061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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