Healthcare Provider Details

I. General information

NPI: 1841298080
Provider Name (Legal Business Name): DR. THOMAS W MEAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N MAIN ST
WATERBURY VT
05676-1835
US

IV. Provider business mailing address

31 N MAIN ST
WATERBURY VT
05676-1835
US

V. Phone/Fax

Practice location:
  • Phone: 802-244-1360
  • Fax: 802-244-1399
Mailing address:
  • Phone: 802-244-1360
  • Fax: 802-244-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000157
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: