Provider Demographics
NPI:1659591774
Name:MANCHESTER EYE CARE PC
Entity Type:Organization
Organization Name:MANCHESTER EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLEIGH
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:MCNEALUS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:802-362-2020
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:802-362-2020
Mailing Address - Fax:802-362-2524
Practice Address - Street 1:VILLAGE MALL 4363 RTE 7A
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255
Practice Address - Country:US
Practice Address - Phone:802-362-2020
Practice Address - Fax:802-362-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0280000269156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT63015OtherMVP
VTMANC19514OtherBC AND BS
VTVN0401Medicare ID - Type Unspecified
VTMANC19514OtherBC AND BS
VT0002916Medicare PIN