Provider Demographics
NPI:1093894792
Name:TREMAINE OPTICIANS
Entity Type:Organization
Organization Name:TREMAINE OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:603-752-3382
Mailing Address - Street 1:148 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2400
Mailing Address - Country:US
Mailing Address - Phone:603-752-3382
Mailing Address - Fax:603-752-1606
Practice Address - Street 1:148 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2400
Practice Address - Country:US
Practice Address - Phone:603-752-3382
Practice Address - Fax:603-752-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH230156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008873Medicaid
0632600001Medicare ID - Type Unspecified