Provider Demographics
NPI:1285637249
Name:O'BRIEN, JOSEPH PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILIP
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DORSET ST
Mailing Address - Street 2:STE # 25
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6241
Mailing Address - Country:US
Mailing Address - Phone:802-863-3000
Mailing Address - Fax:802-863-3001
Practice Address - Street 1:100 DORSET ST
Practice Address - Street 2:STE # 25
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6241
Practice Address - Country:US
Practice Address - Phone:802-863-3000
Practice Address - Fax:802-863-3001
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4125443OtherMVP HEALTHCARE
VTOVN3351Medicaid
VT3733570OtherCIGNA HEALTHCARE
VTP00179942OtherRAILROAD MEDICARE
VT68019OtherBLUE CROSS/BLUE SHIELD VT
VTP00179942OtherRAILROAD MEDICARE
VTVN3608Medicare ID - Type Unspecified