Provider Demographics
NPI:1609186170
Name:MILTON FAMILY EYECARE
Entity Type:Organization
Organization Name:MILTON FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOURDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-871-5718
Mailing Address - Street 1:16 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3779
Mailing Address - Country:US
Mailing Address - Phone:802-871-5718
Mailing Address - Fax:802-871-5950
Practice Address - Street 1:16 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3779
Practice Address - Country:US
Practice Address - Phone:802-871-5718
Practice Address - Fax:802-871-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030427694OtherCBA
59V024OtherMVP
VT6168371OtherCIGNA
VT58749OtherBCBS
VT59298OtherVERMONT MANAGED CARE
VTVT7945Medicare PIN
VT59298OtherVERMONT MANAGED CARE
VT6168371OtherCIGNA