Provider Demographics
NPI:1063563492
Name:GARY E COLE ODPC
Entity type:Organization
Organization Name:GARY E COLE ODPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-356-3000
Mailing Address - Street 1:1319 WHITE MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5155
Mailing Address - Country:US
Mailing Address - Phone:603-356-3000
Mailing Address - Fax:603-356-4101
Practice Address - Street 1:1319 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5155
Practice Address - Country:US
Practice Address - Phone:603-356-3000
Practice Address - Fax:603-356-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH065095001OtherMEDICARE DMERC
NH0650950001OtherMEDICARE NSC DME
NH0650950001OtherMEDICARE NSC DME