=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477938041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTFIELD OPHTHALMOLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2015
-----------------------------------------------------
Last Update Date | 07/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 ORCHARD VIEW DR
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-421-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 ORCHARD VIEW DR
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JOAN POEHLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-437-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0903
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------