Provider Demographics
NPI:1316577794
Name:GUNNING, JAIME (COVT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:GUNNING
Suffix:
Gender:F
Credentials:COVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2305
Mailing Address - Country:US
Mailing Address - Phone:603-644-6100
Mailing Address - Fax:603-657-9085
Practice Address - Street 1:2075 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2305
Practice Address - Country:US
Practice Address - Phone:603-627-7305
Practice Address - Fax:603-657-9085
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-101201152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy