Provider Demographics
NPI:1134146228
Name:FELTUS, STEPHEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:FELTUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEMORIAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8321
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:2000 MEMORIAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8321
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:802-748-4838
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000162152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008315Medicaid
VT0008315Medicaid
VTVT8315Medicare ID - Type Unspecified