Basic Information
| Provider Information | |||||||||
| NPI: | 1427200724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BLOCK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 TSIENNETO RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030381584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034344193 | ||||||||
| FaxNumber: | 6034376804 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 TSIENNETO ROAD SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034344193 | ||||||||
| FaxNumber: | 6034376804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0823 | NH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.