Provider Demographics
NPI:1508047119
Name:JAMES R VITALE
Entity Type:Organization
Organization Name:JAMES R VITALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-382-8989
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:161 MAIN STREET
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-0309
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH367NH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587881Medicaid
NHT25709Medicare UPIN
NH80587881Medicaid
NHRE8105Medicare PIN