Basic Information
| Provider Information | |||||||||
| NPI: | 1669685368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERRIMACK VISION CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2075 S. WILLOW STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031032305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036446100 | ||||||||
| FaxNumber: | 6033140404 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 D. W. HWY | ||||||||
| Address2: | |||||||||
| City: | MERRIMACK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030544143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034240404 | ||||||||
| FaxNumber: | 6034241147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | TROTTIER | ||||||||
| AuthorizedOfficialFirstName: | KARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6036446100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NH0769 | NH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | NH0616 | NH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 0550 | NH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 0616 | NH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 0769 | NH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | NH0550 | NH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.