Provider Demographics
NPI:1558338749
Name:NORTHWEST CORNEAL CONSULTANTS PA
Entity Type:Organization
Organization Name:NORTHWEST CORNEAL CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LASONDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-430-5225
Mailing Address - Street 1:1500A LAFAYETTE RD
Mailing Address - Street 2:#290
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8607
Mailing Address - Country:US
Mailing Address - Phone:603-430-5225
Mailing Address - Fax:603-430-1230
Practice Address - Street 1:155 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4125
Practice Address - Country:US
Practice Address - Phone:603-430-5225
Practice Address - Fax:603-430-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty