MEDICARE: EYESIGHT OPHTHALMIC SERVICES PA

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1790724508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYESIGHT OPHTHALMIC SERVICES PA

Provider Business Mailing Address
First Line	:	330 BORTHWICK AVE
Second Line	:	SUITE 307
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4174
Country	:	US
Telephone Number	:	603-436-1773
Fax Number	:	603-433-6244

Provider Business Practice Location Address
First Line	:	21 WHITEHALL RD
Second Line	:	SUITE 300
City	:	ROCHESTER
State	:	NH
Zip	:	03867-3236
Country	:	US
Telephone Number	:	603-436-1773
Fax Number	:	603-433-6244

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. VIRGINIA STANDEN
Credential	:
Telephone Number	:	603-436-1773

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/22/2020

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