Provider Demographics
NPI:1902853559
Name:EYE VERMONT LLC
Entity Type:Organization
Organization Name:EYE VERMONT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-863-3000
Mailing Address - Street 1:100 DORSET ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6241
Mailing Address - Country:US
Mailing Address - Phone:802-863-3000
Mailing Address - Fax:802-863-3001
Practice Address - Street 1:100 DORSET ST
Practice Address - Street 2:SUITE 25
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-863-3000
Practice Address - Fax:802-863-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTDF3986OtherMEDICARE RAILROAD
VT0VN3977Medicaid
EYEV00069292OtherBLUE SHIELD OF VT
VTDF3986OtherMEDICARE RAILROAD