Healthcare Provider Details

I. General information

NPI: 1134146228
Provider Name (Legal Business Name): STEPHEN A FELTUS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/19/2012
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 Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number030-0000162
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: