MEDICARE: JERRY ALBERT BARCELOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	300000196	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750393211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY ALBERT BARCELOW

Provider Business Mailing Address
First Line	:	1593 VT RTE 107
Second Line	:
City	:	BETHEL
State	:	VT
Zip	:	05032-4456
Country	:	US
Telephone Number	:	802-234-9728
Fax Number	:	802-234-9732

Provider Business Practice Location Address
First Line	:	1593 VT RTE 107
Second Line	:
City	:	BETHEL
State	:	VT
Zip	:	05032-4456
Country	:	US
Telephone Number	:	802-234-9728
Fax Number	:	802-234-9732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	12/11/2014

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Directions to “ JERRY ALBERT BARCELOW ” Practice Location

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