Provider Demographics
NPI:1407024011
Name:BELANGER, JAMES R (OD, MS, FAAO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BELANGER
Suffix:
Gender:M
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-3020
Mailing Address - Country:US
Mailing Address - Phone:603-382-8989
Mailing Address - Fax:603-382-1151
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-3020
Practice Address - Country:US
Practice Address - Phone:603-382-8989
Practice Address - Fax:603-382-1151
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30356809Medicaid