Provider Demographics
NPI:1740442417
Name:OPTICAL EXPRESSIONS BERLIN, LLC
Entity type:Organization
Organization Name:OPTICAL EXPRESSIONS BERLIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-223-2090
Mailing Address - Street 1:14 N MAIN ST STE 4002
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4505
Mailing Address - Country:US
Mailing Address - Phone:802-223-2090
Mailing Address - Fax:802-223-5336
Practice Address - Street 1:14 N MAIN ST STE 4002
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4505
Practice Address - Country:US
Practice Address - Phone:802-223-2090
Practice Address - Fax:802-223-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTL0023504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty