Provider Demographics
NPI:1558770594
Name:PINCOMBE & WILLIS
Entity Type:Organization
Organization Name:PINCOMBE & WILLIS
Other - Org Name:802 EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-862-0023
Mailing Address - Street 1:1185 SHELBURNE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7701
Mailing Address - Country:US
Mailing Address - Phone:802-862-0023
Mailing Address - Fax:802-862-0665
Practice Address - Street 1:1185 SHELBURNE RD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-0023
Practice Address - Fax:802-862-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030000327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030000327OtherVT BOARD OF OPTOMETRY