Provider Demographics
NPI:1689417404
Name:MANDEVILLE, CAROLINE (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:MANDEVILLE
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 1:11 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3271
Mailing Address - Country:US
Mailing Address - Phone:914-582-3441
Mailing Address - Fax:
Practice Address - Street 1:10 S VILLAGE DR STE 420
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3317
Practice Address - Country:US
Practice Address - Phone:603-893-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty