Provider Demographics
NPI:1457319816
Name:RUTLAND OPTICAL INC
Entity Type:Organization
Organization Name:RUTLAND OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-0121
Mailing Address - Street 1:28 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4015
Mailing Address - Country:US
Mailing Address - Phone:802-775-0121
Mailing Address - Fax:802-747-6680
Practice Address - Street 1:28 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4015
Practice Address - Country:US
Practice Address - Phone:802-775-0121
Practice Address - Fax:802-747-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT43156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT049454000154OtherMEDICARE SUPPLIER NUMBER
VT049454000154OtherMEDICARE SUPPLIER NUMBER