Provider Demographics
NPI:1194824680
Name:WOLF, NANCY EILEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:EILEEN
Last Name:WOLF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:EILEEN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:39 SOUTH RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-836-5353
Mailing Address - Fax:603-836-5356
Practice Address - Street 1:39 SOUTH RIVER ROAD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-836-5353
Practice Address - Fax:603-836-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE4082Medicare PIN