Provider Demographics
NPI:1669692786
Name:MCNEALUS, MARLEIGH HELEN (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:MARLEIGH
Middle Name:HELEN
Last Name:MCNEALUS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0567
Mailing Address - Country:US
Mailing Address - Phone:802-362-2020
Mailing Address - Fax:802-862-2524
Practice Address - Street 1:4363 ROUTE 7A
Practice Address - Street 2:VILLAGE MALL
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-0567
Practice Address - Country:US
Practice Address - Phone:802-362-2020
Practice Address - Fax:802-362-2524
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT02800000269156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0280000269OtherSTATE OF VERMONT