Healthcare Provider Details

I. General information

NPI: 1942302377
Provider Name (Legal Business Name): CONCORD EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST SUITE 1600
CONCORD NH
03301
US

IV. Provider business mailing address

514 SOUTH ST
BOW NH
03304-3419
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2020
  • Fax: 603-227-9992
Mailing address:
  • Phone: 603-224-2020
  • Fax: 603-227-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: BRADFORD S HALL
Title or Position: PRESIDENT
Credential: MD
Phone: 603-224-2020