Provider Demographics
NPI:1043491905
Name:RONALD W. DOUVILLE PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:RONALD W. DOUVILLE PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOUVILLE,
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-424-4030
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1059
Mailing Address - Country:US
Mailing Address - Phone:603-424-4030
Mailing Address - Fax:603-424-7277
Practice Address - Street 1:395 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4128
Practice Address - Country:US
Practice Address - Phone:603-424-4030
Practice Address - Fax:603-424-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587884Medicaid
NHRE1359Medicare PIN
NH0667150001Medicare NSC
NVU05724Medicare UPIN