Provider Demographics
NPI:1699946350
Name:MCDONALD, FRED
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 DW HWY
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220-3045
Mailing Address - Country:US
Mailing Address - Phone:603-527-1100
Mailing Address - Fax:603-528-5800
Practice Address - Street 1:96 DW HWY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-3045
Practice Address - Country:US
Practice Address - Phone:603-527-1100
Practice Address - Fax:603-528-5800
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008781Medicaid