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General NPI Number Information
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NPI Number | 1912120783
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Entity Type | Organization
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Legal Business Name | ROBERT J COTTER BRATTLEBORO FAMILY EYE CARE
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 328 WESTERN AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6240
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Country | US
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Telephone | 802-254-9012
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Fax |
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Provider Business Mailing Address
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Address Line | 328 WESTERN AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6240
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Country | US
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Telephone | 802-254-9012
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ROBERT JOHN COTTER
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Credential | O.D.
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Telephone | 802-254-9012
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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 | 030-0000238
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License Number State | VT
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