Provider Demographics
NPI:1629033394
Name:DUFF, JOHN C (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DUFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6619
Mailing Address - Country:US
Mailing Address - Phone:802-254-6611
Mailing Address - Fax:802-258-4655
Practice Address - Street 1:399 CANAL ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6619
Practice Address - Country:US
Practice Address - Phone:802-254-6611
Practice Address - Fax:802-258-4655
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030000175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006601Medicaid
VT410003059OtherRAILROAD MEDICARE
VT0006601Medicaid
VT0175890002Medicare NSC
VTVT6601Medicare PIN
VTVT9295Medicare PIN