Healthcare Provider Details

I. General information

NPI: 1396842670
Provider Name (Legal Business Name): VERMONT FAMILY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5399 WILLISTON RD SUITE 102
WILLISTON VT
05495-5320
US

IV. Provider business mailing address

380 POKER HILL RD
UNDERHILL VT
05489-9610
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-5428
  • Fax:
Mailing address:
  • Phone: 802-899-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number030-0000228
License Number StateVT

VIII. Authorized Official

Name: DR. CHARLES ROBERT CYR
Title or Position: PRESIDENT
Credential: O.D.
Phone: 802-864-5428