Provider Demographics
NPI:1952396988
Name:PARENTEAU, MARIKA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIKA
Middle Name:
Last Name:PARENTEAU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5452 US ROUTE 5
Mailing Address - Street 2:STE H
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9870
Mailing Address - Country:US
Mailing Address - Phone:802-334-1515
Mailing Address - Fax:802-334-2935
Practice Address - Street 1:5452 US ROUTE 5
Practice Address - Street 2:STE H
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9870
Practice Address - Country:US
Practice Address - Phone:802-334-1515
Practice Address - Fax:802-334-2935
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTP00077082OtherRAILROAD MEDICARE
VT29394OtherBLUE CROSS
VT4288070001OtherDMERC
VTVN1538Medicare ID - Type Unspecified
VTP00077082OtherRAILROAD MEDICARE