Healthcare Provider Details

I. General information

NPI: 1245413038
Provider Name (Legal Business Name): PETER J KAZANOVICZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 S RIVER RD UNIT 14A
BEDFORD NH
03110-6971
US

IV. Provider business mailing address

169 S RIVER RD UNIT 14A
BEDFORD NH
03110-6971
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-5200
  • Fax: 603-644-2354
Mailing address:
  • Phone: 603-622-5200
  • Fax: 603-644-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER J KAZANOVICZ
Title or Position: BOARD CERTIFIED OCULARIST/OWNER
Credential: B.C.O.
Phone: 603-622-5200