Provider Demographics
NPI:1043046550
Name:GRANITE STATE OPHTHALMIC ASSOCIATES PLLC
Entity type:Organization
Organization Name:GRANITE STATE OPHTHALMIC ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:LORANGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-714-4235
Mailing Address - Street 1:189 ELM ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4738
Mailing Address - Country:US
Mailing Address - Phone:603-213-6614
Mailing Address - Fax:603-213-6634
Practice Address - Street 1:189 ELM ST STE 6
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4738
Practice Address - Country:US
Practice Address - Phone:603-213-6614
Practice Address - Fax:603-213-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty