MEDICARE: MRS. MIRANDA KIRSTIN RENFROW DO

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
1	207W00000X	Ophthalmology Physician	4949	OK
2	207W00000X	Ophthalmology Physician	032-0129313	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	OKA102503	OTHER	OK	PTAN MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598915332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA KIRSTIN RENFROW DO

Provider Business Mailing Address
First Line	:	1290 HOSPITAL DR STE 5
Second Line	:
City	:	SAINT JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-8126
Fax Number	:	802-748-2208

Provider Business Practice Location Address
First Line	:	1290 HOSPITAL DR STE 5
Second Line	:
City	:	SAINT JOHNSBURY
State	:	VT
Zip	:	05819-9205
Country	:	US
Telephone Number	:	802-748-8126
Fax Number	:	802-748-2208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	07/21/2022

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Directions to “ MRS. MIRANDA KIRSTIN RENFROW DO” Practice Location

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