Provider Demographics
NPI:1124434170
Name:MONADNOCK EYE PHYSICIANS AND SURGEONS, P.C.
Entity type:Organization
Organization Name:MONADNOCK EYE PHYSICIANS AND SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-924-7070
Mailing Address - Street 1:454 OLD STREET RD
Mailing Address - Street 2:STE 204
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1294
Mailing Address - Country:US
Mailing Address - Phone:603-924-7070
Mailing Address - Fax:
Practice Address - Street 1:454 OLD STREET RD
Practice Address - Street 2:STE 204
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1294
Practice Address - Country:US
Practice Address - Phone:603-924-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty