Healthcare Provider Details

I. General information

NPI: 1316073166
Provider Name (Legal Business Name): DEBORAH VALLIERES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LOUDON RD SUITE #1170
CONCORD NH
03301-8005
US

IV. Provider business mailing address

270 LOUDON RD SUITE #1170
CONCORD NH
03301-8005
US

V. Phone/Fax

Practice location:
  • Phone: 603-223-9606
  • Fax: 603-717-7106
Mailing address:
  • Phone: 603-223-9606
  • Fax: 603-717-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0647
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: