Healthcare Provider Details

I. General information

NPI: 1316933583
Provider Name (Legal Business Name): NORTHEAST VISION CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5452 US ROUTE 5 STE H
NEWPORT VT
05855-9870
US

IV. Provider business mailing address

5452 US ROUTE 5 STE H
NEWPORT VT
05855-9870
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-1515
  • Fax: 802-334-2935
Mailing address:
  • Phone: 802-334-1515
  • Fax: 802-334-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0300000278
License Number StateVT

VIII. Authorized Official

Name: DR. MARIKA PARENTEAU
Title or Position: OWNER/DOCTOR
Credential: OD
Phone: 802-334-1515