Provider Demographics
NPI:1710059084
Name:MICHAEL TAUB OD PC
Entity Type:Organization
Organization Name:MICHAEL TAUB OD PC
Other - Org Name:FAMMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-655-6190
Mailing Address - Street 1:50 MOUNTAINVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-655-6190
Mailing Address - Fax:
Practice Address - Street 1:50 MOUNTAINVIEW DR.
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-655-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014756Medicaid
VTVN3830Medicare PIN