=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114274818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID H. GARBUTT, OD FAAO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2012
-----------------------------------------------------
Last Update Date | 08/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 WASHINGTON HWY
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05661-8715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-888-3153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 698
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05661-0698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID H. GARBUTT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 802-888-3089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------