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General NPI Number Information
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NPI Number | 1083601587
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Entity Type | Organization
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Legal Business Name | NORTHERN VALLEY EYECARE, INC.
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 128 FISHER POND RD
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City | SAINT ALBANS
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State | VT
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Zip | 05478-6058
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Country | US
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Telephone | 802-524-9561
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Fax | 802-524-6060
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Provider Business Mailing Address
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Address Line | 128 FISHER POND RD
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City | SAINT ALBANS
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State | VT
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Zip | 05478-6058
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Country | US
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Telephone | 802-524-9561
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Fax | 802-524-6060
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. GRETA M. BOULERICE
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Credential |
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Telephone | 802-524-9561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 328, 140, 263
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License Number State | VT
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