Provider Demographics
NPI:1538356167
Name:EYEGLASS SHOP, PLLC
Entity type:Organization
Organization Name:EYEGLASS SHOP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-436-4509
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03802-1410
Mailing Address - Country:US
Mailing Address - Phone:603-436-4509
Mailing Address - Fax:603-431-5367
Practice Address - Street 1:38 DANIEL ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3899
Practice Address - Country:US
Practice Address - Phone:603-436-4509
Practice Address - Fax:603-431-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1051349OtherHARVARD PILGRIM
NH1538356167OtherUNITED HEALTH CARE
NH1538356167OtherVISION SEVICE PLAN
NH0904169Y0NH01OtherBLUE CROSS BLUE SHEILD
NH9925868OtherCIGNA
NH1538356167OtherEBPA
NH1538356167OtherTRI CARE
NH27079OtherAVESIS
NH30003757Medicaid
NH27079OtherAVESIS
NH1051349OtherHARVARD PILGRIM
NH1538356167OtherUNITED HEALTH CARE