Provider Demographics
NPI:1669685368
Name:MERRIMACK VISION CARE, LLC
Entity Type:Organization
Organization Name:MERRIMACK VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-644-6100
Mailing Address - Street 1:2075 S. WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2305
Mailing Address - Country:US
Mailing Address - Phone:603-644-6100
Mailing Address - Fax:603-314-0404
Practice Address - Street 1:401 D. W. HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4143
Practice Address - Country:US
Practice Address - Phone:603-424-0404
Practice Address - Fax:603-424-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0550152W00000X
NHNH0769152W00000X
NHNH0616152W00000X
NH0550152W00000X
NH0616152W00000X
NH0769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0910370001Medicare NSC
NHV02415Medicare UPIN
NHRE6360Medicare UPIN
NHU76750Medicare UPIN
NHU02219Medicare UPIN