Provider Demographics
NPI:1811656895
Name:GRANITE STATE EYE ASSOCIATES P.L.L.C.
Entity type:Organization
Organization Name:GRANITE STATE EYE ASSOCIATES P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-602-7321
Mailing Address - Street 1:16 PARTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 ROUTE 111
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03811-5120
Practice Address - Country:US
Practice Address - Phone:603-819-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty