Healthcare Provider Details

I. General information

NPI: 1144741992
Provider Name (Legal Business Name): ERICA MICHELLE GUELETTE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2017
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 HOSPITAL DR
ST JOHNSBURY VT
05819
US

IV. Provider business mailing address

114 MAIN ST
MONTPELIER VT
05602-3254
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-3536
  • Fax:
Mailing address:
  • Phone: 802-223-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: