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General NPI Number Information
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NPI Number | 1124434170
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Entity Type | Organization
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Legal Business Name | MONADNOCK EYE PHYSICIANS AND SURGEONS, P.C.
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 454 OLD STREET RD STE 204
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City | PETERBOROUGH
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State | NH
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Zip | 03458-1294
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Country | US
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Telephone | 603-924-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 454 OLD STREET RD STE 204
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City | PETERBOROUGH
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State | NH
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Zip | 03458-1294
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Country | US
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Telephone | 603-924-7070
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR/PHYSICIAN
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Name | GLADYS LEE
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Credential | M.D.
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Telephone | 603-924-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 16594
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License Number State | NH
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