Healthcare Provider Details

I. General information

NPI: 1700212982
Provider Name (Legal Business Name): GREGORY P. GUILMARTIN LICENSED OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2989 SHELBURNE ROAD
SHELBURNE VT
05482
US

IV. Provider business mailing address

2989-1 SHELBURNE RD.
SHELBURNE VT
05482
US

V. Phone/Fax

Practice location:
  • Phone: 802-985-8333
  • Fax: 802-985-5770
Mailing address:
  • Phone: 802-985-8333
  • Fax: 802-985-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number028.0000346
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: