Provider Demographics
NPI:1679922579
Name:PORTSMOUTH EYE PLLC
Entity type:Organization
Organization Name:PORTSMOUTH EYE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CORISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKALLAGAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-436-4509
Mailing Address - Street 1:38 DANIEL ST.
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 DANIEL ST.
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTSMOUTH EYE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty