Provider Demographics
NPI:1831276922
Name:EYE CARE ASSOCIATES OF DERRY PC
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES OF DERRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:603-434-2020
Mailing Address - Street 1:55 CRYSTAL AVE
Mailing Address - Street 2:HOOD COMMONS
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1702
Mailing Address - Country:US
Mailing Address - Phone:603-434-2020
Mailing Address - Fax:603-437-1260
Practice Address - Street 1:55 CRYSTAL AVE
Practice Address - Street 2:HOOD COMMONS
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1702
Practice Address - Country:US
Practice Address - Phone:603-434-2020
Practice Address - Fax:603-437-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH9098Medicare PIN
NH0268430001Medicare NSC