Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | NH 0704 | NH |
NPI | 1003858457 |
---|---|
Provider Name | Mr. Fabrice Brenot |
First Address | Manchester, NH 03104-4125 |
Second Address | Manchester, NH 03104-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 21/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30351916 | (05) | NH |
U80692 | (02) | NH |