Provider Demographics
NPI:1831368356
Name:VERMONT EYE SURGERY & LASER CENTER
Entity type:Organization
Organization Name:VERMONT EYE SURGERY & LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACT PERSON
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIOSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-862-1808
Mailing Address - Street 1:1100 HINESBURG RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7613
Mailing Address - Country:US
Mailing Address - Phone:802-862-1808
Mailing Address - Fax:802-862-6664
Practice Address - Street 1:1100 HINESBURG RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7613
Practice Address - Country:US
Practice Address - Phone:802-862-1808
Practice Address - Fax:802-862-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015944Medicaid
VTP00717828OtherRAILROAD MEDICARE
VT471000Medicare PIN