Healthcare Provider Details

I. General information

NPI: 1396101358
Provider Name (Legal Business Name): CONCORD FAMILY VISION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N STATE ST
CONCORD NH
03301-4038
US

IV. Provider business mailing address

8 NORTH STATE STREET
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2512
  • Fax: 603-225-3249
Mailing address:
  • Phone: 603-225-2512
  • Fax: 603-225-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0750
License Number StateNH

VIII. Authorized Official

Name: DR. CHRISTOPHER UDINA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 603-225-2512