MEDICARE: LOIS M SHIOZAWA

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1629246632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOIS M SHIOZAWA

Provider Business Mailing Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-223-3761
Fax Number	:	802-223-5270

Provider Business Practice Location Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-223-3761
Fax Number	:	802-223-5270

Authorized Official
Title or Position	:	DOCTOR
Name	:	LOIS M SHIOZAWA
Credential	:	OD
Telephone Number	:	802-223-3761

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	06/19/2008

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Directions to “LOIS M SHIOZAWA ” Practice Location

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