Basic Information
| Provider Information | |||||||||
| NPI: | 1851366876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAUVETTE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 DANIEL WEBSTER HWY | ||||||||
| Address2: | |||||||||
| City: | MERRIMACK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034240404 | ||||||||
| FaxNumber: | 6034241147 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 DANIEL WEBSTER HWY | ||||||||
| Address2: | |||||||||
| City: | MERRIMACK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034240404 | ||||||||
| FaxNumber: | 6034241147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0550 | NH | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 40353697 | 05 | NH | MEDICAID |