Healthcare Provider Details

I. General information

NPI: 1831368356
Provider Name (Legal Business Name): VERMONT EYE SURGERY & LASER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HINESBURG RD SUITE 101
SOUTH BURLINGTON VT
05403-7613
US

IV. Provider business mailing address

1100 HINESBURG RD SUITE 101
SOUTH BURLINGTON VT
05403-7613
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-1808
  • Fax: 802-862-6664
Mailing address:
  • Phone: 802-862-1808
  • Fax: 802-862-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateVT

VIII. Authorized Official

Name: FREDA CIOSEK
Title or Position: CONTACT PERSON
Credential:
Phone: 802-862-1808