MEDICARE: VERMONT EYE SURGERY & LASER CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center		VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00717828	OTHER	VT	RAILROAD 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	:	1831368356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERMONT EYE SURGERY & LASER CENTER

Provider Business Mailing Address
First Line	:	1100 HINESBURG RD
Second Line	:	SUITE 101
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7613
Country	:	US
Telephone Number	:	802-862-1808
Fax Number	:	802-862-6664

Provider Business Practice Location Address
First Line	:	1100 HINESBURG RD
Second Line	:	SUITE 101
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7613
Country	:	US
Telephone Number	:	802-862-1808
Fax Number	:	802-862-6664

Authorized Official
Title or Position	:	CONTACT PERSON
Name	:	FREDA CIOSEK
Credential	:
Telephone Number	:	802-862-1808

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/04/2010

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Directions to “VERMONT EYE SURGERY & LASER CENTER ” Practice Location

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