Individual
MRS. LIA ANN SPRAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
764 2ND ST, MANCHESTER, NH 03102-5210
(603) 669-3925
(603) 669-0380
Mailing address
764 2ND ST, MANCHESTER, NH 03102-5210
(603) 669-3925
(603) 669-0380
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0763
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30353107
—
NH
01
—
CL RE 786301
MEDICARE IDENTIFIER
NH
Enumeration date
02/23/2006
Last updated
07/08/2024
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