Healthcare Provider Details

I. General information

NPI: 1831183268
Provider Name (Legal Business Name): CONCORD OPHTHALMOLOGIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY ST STE 100
CONCORD NH
03301
US

IV. Provider business mailing address

2 PILLSBURY ST STE 100
CONCORD NH
03301-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1104
  • Fax: 603-228-7061
Mailing address:
  • Phone: 603-228-1104
  • Fax: 603-228-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNH

VIII. Authorized Official

Name: STEPHEN VEINER
Title or Position: ADMIN
Credential:
Phone: 603-224-2020