Provider Demographics
NPI:1366002057
Name:LEVESQUE, JANELLE ROSE (OD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ROSE
Last Name:LEVESQUE
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 1:1 KIMBALL WAY
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-2113
Mailing Address - Country:US
Mailing Address - Phone:603-834-2973
Mailing Address - Fax:
Practice Address - Street 1:304 SHEEP DAVIS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5736
Practice Address - Country:US
Practice Address - Phone:603-226-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty