Provider Demographics
NPI:1104065994
Name:NATHAN H DRUM, OD
Entity type:Organization
Organization Name:NATHAN H DRUM, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DRUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-788-2031
Mailing Address - Street 1:95 MAIN ST
Mailing Address - Street 2:PO BOX 527
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3072
Mailing Address - Country:US
Mailing Address - Phone:603-788-2031
Mailing Address - Fax:603-788-2508
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3065
Practice Address - Country:US
Practice Address - Phone:603-237-4500
Practice Address - Fax:603-237-9900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER EYE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-18
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000272152W00000X
NH552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010684Medicaid
NH30010684Medicaid
NHRE0718Medicare PIN