Provider Demographics
NPI:1811910136
Name:VITALE, JAMES RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:VITALE
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 1:161 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-3020
Mailing Address - Country:US
Mailing Address - Phone:603-382-8989
Mailing Address - Fax:603-382-1151
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-3020
Practice Address - Country:US
Practice Address - Phone:603-382-8989
Practice Address - Fax:603-382-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587881Medicaid
NHT25709Medicare UPIN
NHUX6048Medicare PIN