| NPI | 1790739340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY NILES Practice Administrator 802-447-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 207W00000X Ophthalmology | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-07-21 |