Healthcare Provider Details

I. General information

NPI: 1699793430
Provider Name (Legal Business Name): RICHARD DELBIANCO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEN ST STE 12
RUTLAND VT
05701-4564
US

IV. Provider business mailing address

69 ALLEN ST STE 12
RUTLAND VT
05701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-0634
  • Fax:
Mailing address:
  • Phone: 802-773-0634
  • Fax: 802-772-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number221
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: