Provider Demographics
NPI:1588398242
Name:LETELLIER, CAROLYN (ABOC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:LETELLIER
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WHITELAW DR
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4421
Mailing Address - Country:US
Mailing Address - Phone:603-915-6478
Mailing Address - Fax:
Practice Address - Street 1:486 WHITE MOUNTAIN HWY STE D
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-4215
Practice Address - Country:US
Practice Address - Phone:603-915-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1695156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician