Healthcare Provider Details

I. General information

NPI: 1124117973
Provider Name (Legal Business Name): EYECARE OF VERMONT, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 COLLEGE ST
BURLINGTON VT
05401-8352
US

IV. Provider business mailing address

230 COLLEGE ST
BURLINGTON VT
05401-8352
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-3330
  • Fax: 802-658-7464
Mailing address:
  • Phone: 802-658-3330
  • Fax: 802-658-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number030-0000265
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number030-0000293
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number030-0000156
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number030-0000338
License Number StateVT

VIII. Authorized Official

Name: MR. JON D ERIKSSON
Title or Position: OWNER MANAGER
Credential: O.D.
Phone: 802-878-5509