Provider Demographics
NPI:1154451300
Name:SOARES OCULAR SURGERY
Entity Type:Organization
Organization Name:SOARES OCULAR SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-728-2460
Mailing Address - Street 1:124 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-8952
Mailing Address - Country:US
Mailing Address - Phone:802-728-2460
Mailing Address - Fax:802-728-2457
Practice Address - Street 1:124 MEADOW LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-8952
Practice Address - Country:US
Practice Address - Phone:802-728-2460
Practice Address - Fax:802-728-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008693261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTNX4853Medicare PIN