Provider Demographics
NPI:1649264805
Name:GILLIGAN, LINDA SQUILLACE (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SQUILLACE
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 SECOND ST
Mailing Address - Street 2:MANCHESTER EYE ASSOICATES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5200
Mailing Address - Country:US
Mailing Address - Phone:603-668-2010
Mailing Address - Fax:603-668-3944
Practice Address - Street 1:581 SECOND ST
Practice Address - Street 2:MANCHESTER EYE ASSOICATES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5200
Practice Address - Country:US
Practice Address - Phone:603-668-2010
Practice Address - Fax:603-668-3944
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63207Medicare UPIN
RE4271Medicare ID - Type Unspecified