Healthcare Provider Details

I. General information

NPI: 1053492850
Provider Name (Legal Business Name): OPTICAL EXPRESSIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEMORIAL DR SUITE 6
ST JOHNSBURY VT
05819-8321
US

IV. Provider business mailing address

2000 MEMORIAL DR SUITE 6
ST JOHNSBURY VT
05819-8321
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-3536
  • Fax: 802-748-4838
Mailing address:
  • Phone: 802-748-3536
  • Fax: 802-748-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SANDY BUTKOVICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-748-3536