Provider Demographics
NPI:1396101358
Name:CONCORD FAMILY VISION, PLLC
Entity type:Organization
Organization Name:CONCORD FAMILY VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:UDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-225-2512
Mailing Address - Street 1:8 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-225-2512
Mailing Address - Fax:603-225-3249
Practice Address - Street 1:8 N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4038
Practice Address - Country:US
Practice Address - Phone:603-225-2512
Practice Address - Fax:603-225-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0750152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008880Medicaid
NH030353247Medicaid
NHT91133Medicare UPIN
NH030353247Medicaid