Provider Demographics
NPI:1386832756
Name:ADVANCED EYECARE, PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAPENTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-447-8700
Mailing Address - Street 1:5222 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9700
Mailing Address - Country:US
Mailing Address - Phone:802-366-8051
Mailing Address - Fax:
Practice Address - Street 1:5222 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9700
Practice Address - Country:US
Practice Address - Phone:802-366-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0965940003Medicare NSC