Healthcare Provider Details

I. General information

NPI: 1811633944
Provider Name (Legal Business Name): OPTOMETRY ONSITE NEW ENGLAND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WINDSOR RD
BOW NH
03304-5218
US

IV. Provider business mailing address

11 WINDSOR RD
BOW NH
03304-5218
US

V. Phone/Fax

Practice location:
  • Phone: 603-568-9257
  • Fax:
Mailing address:
  • Phone: 603-568-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMY VAN WYCK BORBIDGE
Title or Position: MANAGER
Credential: OD
Phone: 603-568-9257