Provider Demographics
NPI:1770547044
Name:KNEE, DOUGLAS E (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:KNEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MOULTONBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03254-3334
Mailing Address - Country:US
Mailing Address - Phone:603-284-7132
Mailing Address - Fax:
Practice Address - Street 1:561 MAIN ST
Practice Address - Street 2:WALMART
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-4901
Practice Address - Country:US
Practice Address - Phone:603-752-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587875Medicaid
NHRE4521Medicare ID - Type UnspecifiedNHIC MEDICARE