Provider Demographics
NPI:1699714329
Name:NORTHEAST CORNEAL CONSULTANTS, PA
Entity type:Organization
Organization Name:NORTHEAST CORNEAL CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LASONDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-430-5225
Mailing Address - Street 1:155 GRIFFIN RD # 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4125
Mailing Address - Country:US
Mailing Address - Phone:603-430-5225
Mailing Address - Fax:603-430-1230
Practice Address - Street 1:155 GRIFFIN RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-430-5225
Practice Address - Fax:603-430-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHDB2576OtherRAILROAD MEDICARE
ME129370000Medicaid
NH30009219Medicaid
NHDB2576OtherRAILROAD MEDICARE
NHRE3985Medicare UPIN