Provider Demographics
NPI:1710917182
Name:DCJ COMPANY
Entity Type:Organization
Organization Name:DCJ COMPANY
Other - Org Name:PRO OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:603-298-5517
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-2014
Mailing Address - Country:US
Mailing Address - Phone:603-298-5517
Mailing Address - Fax:603-298-7898
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2014
Practice Address - Country:US
Practice Address - Phone:603-298-5517
Practice Address - Fax:603-298-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008903Medicaid
VT1000922Medicaid
NH30008903Medicaid