Provider Demographics
NPI:1497711261
Name:MCMAHON, VINCENT P (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:MCMAHON
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 1:474 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-352-7803
Mailing Address - Fax:603-354-3165
Practice Address - Street 1:474 WEST STREET
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-352-7803
Practice Address - Fax:603-654-3165
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30356560Medicaid
NH2210633OtherCIGNA
NH0907885Y0NH02OtherANTHEM
NHNH788501Medicare PIN
NH0907885Y0NH02OtherANTHEM
NH2210633OtherCIGNA
T25710Medicare UPIN