Provider Demographics
NPI:1245395045
Name:COLLINS, ROGER P (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:P
Last Name:COLLINS
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 1:395 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-669-0447
Mailing Address - Fax:603-669-0850
Practice Address - Street 1:395 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-669-0447
Practice Address - Fax:603-669-0850
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH237152W00000X
NHNH0237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA1147OtherHARVARD PILGRIM
0907760Y0NH01OtherBCBS
8730OtherCIGNA
NH80587760Medicaid
NH0165450001Medicare NSC
NHNH7760Medicare PIN
8730OtherCIGNA