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General NPI Number Information
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NPI Number | 1780873877
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Entity Type | Organization
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Legal Business Name | DR. ROGER P. COLLINS PROF ASSN
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 395 S MAIN ST
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City | MANCHESTER
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State | NH
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Zip | 03102-4841
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Country | US
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Telephone | 603-669-0447
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Fax | 603-669-0850
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Provider Business Mailing Address
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Address Line | 395 S MAIN ST
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City | MANCHESTER
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State | NH
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Zip | 03102-4841
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Country | US
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Telephone | 603-669-0447
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Fax | 603-669-0850
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER PAUL COLLINS
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Credential | OD
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Telephone | 603-669-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 237
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License Number State | NH
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