Healthcare Provider Details

I. General information

NPI: 1902743149
Provider Name (Legal Business Name): CAMERON GAIL LORY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMERON REDIKER

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAPLE ST STE 1
WHITE RIVER JUNCTION VT
05001-7029
US

IV. Provider business mailing address

155 MAPLE ST STE 1
WHITE RIVER JUNCTION VT
05001-7029
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-3300
  • Fax: 802-295-6581
Mailing address:
  • Phone: 802-295-3300
  • Fax: 802-295-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: