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General NPI Number Information
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NPI Number | 1164669776
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Entity Type | Organization
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Legal Business Name | RUTLAND EYE PHYSICIANS, LLC
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 73 CENTER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-773-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 73 CENTER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-773-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERED SOBEL
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Credential | M.D
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Telephone | 802-773-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 042-0011634
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License Number State | VT
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