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General NPI Number Information
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NPI Number | 1053511147
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Entity Type | Organization
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Legal Business Name | VERMONT OPTICAL CORP
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 69 ALLEN ST SUITE 15
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-774-5124
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Fax | 802-774-5129
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Provider Business Mailing Address
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Address Line | 69 ALLEN ST SUITE 15
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-774-5124
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Fax | 802-774-5129
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY CHANDLER BIRAJICLIAN
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Credential | OPTICIAN
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Telephone | 802-774-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 028-0000350
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License Number State | VT
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