Healthcare Provider Details

I. General information

NPI: 1578511945
Provider Name (Legal Business Name): JULI A LARSON PC VERMONT EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HINESBURG RD SUITE 201
SOUTH BURLINGTON VT
05403-7613
US

IV. Provider business mailing address

1100 HINESBURG RD SUITE 201
SOUTH BURLINGTON VT
05403-7613
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number0420008600
License Number StateVT

VIII. Authorized Official

Name: DR. JULI LARSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 802-862-1808