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NPI Code Detail

MEDICARE: WINDHAM FAMILY EYE CARE PLLC

MEDICARE: WINDHAM FAMILY EYE CARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0766NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11437162963OTHERNHNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134285372
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDHAM FAMILY EYE CARE PLLC
Provider Business Mailing Address
First Line : 63 RANGE RD
Second Line : SUITE 104
City : WINDHAM
State : NH
Zip : 03087-2098
Country : US
Telephone Number : 603-318-9108
Fax Number :
Provider Business Practice Location Address
First Line : 63 RANGE RD
Second Line : SUITE 104
City : WINDHAM
State : NH
Zip : 03087-2098
Country : US
Telephone Number : 603-318-9108
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. JENNIFER MARIE SHANLEY
Credential : OD
Telephone Number : 603-318-9108
Provider Enumeration Date : 12/30/2006
Last Update Date : 08/22/2020

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Directions to “WINDHAM FAMILY EYE CARE PLLC ” Practice Location

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