Provider Demographics
NPI:1114004363
Name:ALLARD, DENIS ROGER (OD)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:ROGER
Last Name:ALLARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BAY ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3004
Mailing Address - Country:US
Mailing Address - Phone:603-622-1731
Mailing Address - Fax:603-668-3843
Practice Address - Street 1:25 BAY ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3004
Practice Address - Country:US
Practice Address - Phone:603-622-1731
Practice Address - Fax:603-668-3843
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000018Medicaid
NH80000018Medicaid
NH0143470001Medicare NSC