Healthcare Provider Details

I. General information

NPI: 1811256985
Provider Name (Legal Business Name): OCIUS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 OPERA HOUSE SQ
CLAREMONT NH
03743-5407
US

IV. Provider business mailing address

111 US ROUTE 4A
LEBANON NH
03766-2119
US

V. Phone/Fax

Practice location:
  • Phone: 603-287-1717
  • Fax: 603-287-1410
Mailing address:
  • Phone: 603-287-1717
  • Fax: 603-287-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number037311-23
License Number StateNH

VIII. Authorized Official

Name: DR. GORDON C BLACK
Title or Position: OWNER
Credential: DNP, FNP-BC
Phone: 603-287-1717