| NPI | 1124117973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON D ERIKSSON Owner Manager 802-878-5509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030-0000338) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VT 030-0000265) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VT 030-0000293) | |
| 152W00000X Optometrist (Licence: VT 030-0000156) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-03-13 |