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NPI Code Detail

MEDICARE: DR. CHARLES ROBERT CYR O.D.

MEDICARE: DR. CHARLES ROBERT CYR O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist228VT
2152W00000XOptometrist030-0000228VT

General Provider Information

NPI Number : 1104829100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES ROBERT CYR O.D.
Provider Business Mailing Address
First Line : 380 POKER HILL RD
Second Line :
City : UNDERHILL
State : VT
Zip : 05489-9610
Country : US
Telephone Number : 802-899-2105
Fax Number :
Provider Business Practice Location Address
First Line : 5399 WILLISTON RD
Second Line : STE 102
City : WILLISTON
State : VT
Zip : 05495-5321
Country : US
Telephone Number : 802-864-5428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 02/23/2016

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