Healthcare Provider Details

I. General information

NPI: 1720230378
Provider Name (Legal Business Name): THE MEDICAL EYE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RIVER RD
MANCHESTER NH
03104-2423
US

IV. Provider business mailing address

250 RIVER RD
MANCHESTER NH
03104-2423
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-2020
  • Fax: 603-668-0881
Mailing address:
  • Phone: 603-668-2020
  • Fax: 603-668-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE JAMES SHAKER
Title or Position: PRESIDENT
Credential: MD
Phone: 603-668-2020