Provider Demographics
NPI:1396842670
Name:VERMONT FAMILY EYE CARE, INC.
Entity Type:Organization
Organization Name:VERMONT FAMILY EYE CARE, INC.
Other - Org Name:WILLISTON FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-864-5428
Mailing Address - Street 1:380 POKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9610
Mailing Address - Country:US
Mailing Address - Phone:802-899-2105
Mailing Address - Fax:
Practice Address - Street 1:5399 WILLISTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-5320
Practice Address - Country:US
Practice Address - Phone:802-864-5428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3412OtherMEDICARE P-TAN
VTVT5535Medicare PIN
VTT25364Medicare UPIN