Provider Demographics
NPI:1710183124
Name:SEACOAST OPHTHALMOLOGY SIGHT SERVICES, INC.
Entity Type:Organization
Organization Name:SEACOAST OPHTHALMOLOGY SIGHT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-436-7485
Mailing Address - Street 1:738 ISLINGTON ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7217
Mailing Address - Country:US
Mailing Address - Phone:603-436-7485
Mailing Address - Fax:603-436-6484
Practice Address - Street 1:738 ISLINGTON ST
Practice Address - Street 2:UNIT B
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7217
Practice Address - Country:US
Practice Address - Phone:603-436-7485
Practice Address - Fax:603-436-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4499Medicare ID - Type Unspecified