Healthcare Provider Details

I. General information

NPI: 1235804485
Provider Name (Legal Business Name): FOUR YOUR EYES ONLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 WHITTIER HWY
MOULTONBOROUGH NH
03254-3213
US

IV. Provider business mailing address

517 WHITTIER HWY
MOULTONBOROUGH NH
03254-3213
US

V. Phone/Fax

Practice location:
  • Phone: 603-253-5484
  • Fax: 603-253-5484
Mailing address:
  • Phone: 603-253-5484
  • Fax: 603-253-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DOMENICHELLO
Title or Position: OWNER/OPTICIAN
Credential:
Phone: 603-253-5484