Provider Demographics
NPI:1134285372
Name:WINDHAM FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:WINDHAM FAMILY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-318-9108
Mailing Address - Street 1:63 RANGE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2098
Mailing Address - Country:US
Mailing Address - Phone:603-318-9108
Mailing Address - Fax:
Practice Address - Street 1:63 RANGE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2098
Practice Address - Country:US
Practice Address - Phone:603-318-9108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1437162963OtherNPI
NH30354446Medicaid
NH1437162963OtherNPI
NHV01436Medicare UPIN