Provider Demographics
NPI:1821287020
Name:MANCHESTER OPTOMETRIC, PA
Entity Type:Organization
Organization Name:MANCHESTER OPTOMETRIC, PA
Other - Org Name:MANCHESTER-BEDFORD EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-668-2010
Mailing Address - Street 1:779 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5143
Mailing Address - Country:US
Mailing Address - Phone:603-668-2010
Mailing Address - Fax:603-668-3944
Practice Address - Street 1:779 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5143
Practice Address - Country:US
Practice Address - Phone:603-668-2010
Practice Address - Fax:603-668-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH9370Medicare PIN
NH0139820002Medicare NSC