Healthcare Provider Details

I. General information

NPI: 1053239525
Provider Name (Legal Business Name): MICHELLE MCDERMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 ROCHESTER HILL RD
ROCHESTER NH
03867-3241
US

IV. Provider business mailing address

65 ROCHESTER HILL RD
ROCHESTER NH
03867-3241
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-8569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1530
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: