Healthcare Provider Details

I. General information

NPI: 1548987027
Provider Name (Legal Business Name): COURTNEE LANE BARCHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MAIN ST
SALEM NH
03079-3186
US

IV. Provider business mailing address

51 MILK ST
METHUEN MA
01844-4658
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-8628
  • Fax: 603-893-4076
Mailing address:
  • Phone: 978-654-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNH1067
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: