Provider Demographics
NPI:1487742292
Name:LACONIA EYE ASSOCIATES PA
Entity type:Organization
Organization Name:LACONIA EYE ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EYEPHYSICIAN & SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-528-2606
Mailing Address - Street 1:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7625
Mailing Address - Country:US
Mailing Address - Phone:603-528-2388
Mailing Address - Fax:603-528-2805
Practice Address - Street 1:368 HOUNSELL AVE
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6922
Practice Address - Country:US
Practice Address - Phone:603-528-2388
Practice Address - Fax:603-528-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1487742292Medicare PIN
NH4996720001Medicare NSC