Healthcare Provider Details

I. General information

NPI: 1386620789
Provider Name (Legal Business Name): NATHAN H DRUM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 01/23/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MAIN ST STE 2
COLEBROOK NH
03576-2110
US

IV. Provider business mailing address

109 MAIN ST STE 2
COLEBROOK NH
03576-2110
US

V. Phone/Fax

Practice location:
  • Phone: 603-237-4500
  • Fax: 603-237-9900
Mailing address:
  • Phone: 603-237-4500
  • Fax: 603-237-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0300000272
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number552
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: