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General NPI Number Information
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NPI Number | 1932813474
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Entity Type | Organization
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Legal Business Name | HERITAGE EYE CARE LLC
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 81 RIVER ST STE 203
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City | MONTPELIER
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State | VT
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Zip | 05602-3750
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Country | US
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Telephone | 802-223-3761
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Fax | 802-223-5270
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Provider Business Mailing Address
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Address Line | 81 RIVER ST STE 203
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City | MONTPELIER
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State | VT
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Zip | 05602-3750
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Country | US
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Telephone | 802-223-3761
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Fax | 802-223-5270
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | TODD PAGE
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Credential | OD
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Telephone | 802-342-4301
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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 |
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License Number State |
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