MEDICARE: OPTOMETRIC PROVIDERS OF NEW HAMPSHIRE, 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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1972704005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRIC PROVIDERS OF NEW HAMPSHIRE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 417814
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-7814
Country	:	US
Telephone Number	:	800-340-0129
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	175 E HOUSTON ST
Second Line	:	STE 5
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2255
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Authorized Official
Title or Position	:	MANAGER
Name	:	DOLSIE MCDONALD
Credential	:
Telephone Number	:	726-444-4078

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	12/18/2023

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