Healthcare Provider Details

I. General information

NPI: 1255416053
Provider Name (Legal Business Name): OPHTHALMIC CONSULTANTS OF VERMONT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 TIMBER LN
SOUTH BURLINGTON VT
05403-5201
US

IV. Provider business mailing address

55 TIMBER LN
SOUTH BURLINGTON VT
05403-5201
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-2010
  • Fax:
Mailing address:
  • Phone: 802-864-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BROWNELL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 802-864-2010