Provider Demographics
NPI:1154497691
Name:ASTORINO, GERALD P (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:P
Last Name:ASTORINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2202
Mailing Address - Country:US
Mailing Address - Phone:603-647-5418
Mailing Address - Fax:
Practice Address - Street 1:87 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2730
Practice Address - Country:US
Practice Address - Phone:603-935-5966
Practice Address - Fax:603-935-5968
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU75927Medicare UPIN
NHASRE8379Medicare ID - Type Unspecified