=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710183124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEACOAST OPHTHALMOLOGY SIGHT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2007
-----------------------------------------------------
Last Update Date | 02/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 738 ISLINGTON ST UNIT B
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-436-7485
-----------------------------------------------------
Fax | 603-436-6484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 738 ISLINGTON ST UNIT B
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-436-7485
-----------------------------------------------------
Fax | 603-436-6484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW E. NORMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 603-436-7485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 7480
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------