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General NPI Number Information
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NPI Number | 1811256985
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Entity Type | Organization
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Legal Business Name | OCIUS CARE
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 52 OPERA HOUSE SQ
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City | CLAREMONT
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State | NH
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Zip | 03743-5407
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Country | US
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Telephone | 603-287-1717
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Fax | 603-287-1410
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Provider Business Mailing Address
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Address Line | 111 US ROUTE 4A
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City | LEBANON
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State | NH
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Zip | 03766-2119
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Country | US
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Telephone | 603-287-1717
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Fax | 603-287-1410
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON C BLACK
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Credential | DNP, FNP-BC
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Telephone | 603-287-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 037311-23
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License Number State | NH
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