NPIMap

Organization Active NPI

Mascoma Eyecare

  • Optometrist
  • Lebanon, NH
National Provider Identifier
1407160120
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0464 Issued in NH
Legal business name
MASCOMA EYECARE
Practice address
24 Hanover Street
Suite 3a
Lebanon, NH 03766-1334
Phone
(603) 448-2111
Fax
(603) 448-2443
NPI assigned
Aug 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Edward C Warren Jr., O.D.NPI 1699719112
Title
Owner
Phone
(603) 448-2111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 0464 NH Primary

Addresses

Primary practice location

24 Hanover Street
Suite 3a
Lebanon, NH 03766-1334

Mailing address

24 Hanover Street
Suite 3a
Lebanon, NH 03766-1334
Phone (603) 448-2111

National Provider Directory

National Provider Directory

Locations

24 Hanover St
Ste 3A
Lebanon, NH 03766
Phone (603) 448-2111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280966400000",
    "number": "1407160120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HANOVER STREET",
            "address_2": "SUITE 3A",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661334",
            "telephone_number": "603-448-2111",
            "fax_number": "603-448-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 HANOVER STREET",
            "address_2": "SUITE 3A",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661334",
            "telephone_number": "603-448-2111",
            "fax_number": "603-448-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASCOMA EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-08-05",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-448-2111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NH",
            "license": "0464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.