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General NPI Number Information
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NPI Number | 1124515234
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Entity Type | Organization
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Legal Business Name | EYE LOGIC LLC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 158A NH ROUTE 108
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City | DOVER
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State | NH
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Zip | 03820-8812
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Country | US
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Telephone | 603-742-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 347 WASHINGTON ST
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City | DOVER
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State | NH
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Zip | 03820-3630
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Country | US
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Telephone | 603-343-5511
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. DEREK W GUARINO
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Credential | OD
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Telephone | 603-742-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NH0706
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License Number State | NH
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