Provider Demographics
NPI:1245213156
Name:KOHN, BETH H (OD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:H
Last Name:KOHN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3186
Mailing Address - Country:US
Mailing Address - Phone:603-893-8628
Mailing Address - Fax:603-893-4076
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3186
Practice Address - Country:US
Practice Address - Phone:603-893-8628
Practice Address - Fax:603-893-4076
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008308Medicaid
NH30008308Medicaid
RE3749Medicare ID - Type Unspecified