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General NPI Number Information
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NPI Number | 1396101358
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Entity Type | Organization
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Legal Business Name | CONCORD FAMILY VISION, PLLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 8 N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4038
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Country | US
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Telephone | 603-225-2512
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Fax | 603-225-3249
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Provider Business Mailing Address
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Address Line | 8 NORTH STATE STREET
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 603-225-2512
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Fax | 603-225-3249
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHRISTOPHER UDINA
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Credential | OD
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Telephone | 603-225-2512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0750
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License Number State | NH
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