Provider Demographics
NPI:1508967969
Name:CHE, BAO (OD)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:
Last Name:CHE
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 1:30 BIRCH ST
Mailing Address - Street 2:# 1
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2120
Mailing Address - Country:US
Mailing Address - Phone:603-247-2839
Mailing Address - Fax:
Practice Address - Street 1:270 LOUDON RD
Practice Address - Street 2:SUITE #2000
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8005
Practice Address - Country:US
Practice Address - Phone:603-225-8305
Practice Address - Fax:603-224-1386
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4517152W00000X
NH0774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17615Medicare ID - Type UnspecifiedMEDICARE #