Healthcare Provider Details

I. General information

NPI: 1891886644
Provider Name (Legal Business Name): LAUREN GUMP O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 HIGH ST
SOMERSWORTH NH
03878-1011
US

IV. Provider business mailing address

5 PUMPKIN CIR
EXETER NH
03833-3129
US

V. Phone/Fax

Practice location:
  • Phone: 603-692-4222
  • Fax:
Mailing address:
  • Phone: 603-502-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number681
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: