Provider Demographics
NPI:1740243245
Name:SOGOLOFF, HAYES IRVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:HAYES
Middle Name:IRVIN
Last Name:SOGOLOFF
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 1:5138 SHELBURNE RD
Mailing Address - Street 2:P O BOX 428
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6698
Mailing Address - Country:US
Mailing Address - Phone:802-985-2210
Mailing Address - Fax:802-985-8553
Practice Address - Street 1:5138 SHELBURNE RD
Practice Address - Street 2:SUITE 22A
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6698
Practice Address - Country:US
Practice Address - Phone:802-985-2210
Practice Address - Fax:802-985-8553
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000-7936Medicaid
6496810001OtherDME REGION A MEDICARE
VT000-7936Medicaid
VTT25405Medicare UPIN