Provider Demographics
NPI:1083669337
Name:EYESIGHT OPHTHALMIC SERVICES PA
Entity Type:Organization
Organization Name:EYESIGHT OPHTHALMIC SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-436-1773
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-436-1773
Mailing Address - Fax:603-433-6244
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:603-433-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHEYNH9862Medicare ID - Type Unspecified