1790739340 NPI number — ADVANCED EYECARE PC

Table of content: (NPI 1790739340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790739340 NPI number — ADVANCED EYECARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED EYECARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790739340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 DEWEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-447-8700
Provider Business Mailing Address Fax Number:
802-447-1500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-447-8700
Provider Business Practice Location Address Fax Number:
802-447-1500
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NILES
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
802-447-8700

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110072172A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ADVA318-19924 . This is a "VTBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: ADVA318-19924 . This is a "VTBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16004 . This is a "MABS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16004 . This is a "MABS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: VN0966 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1059 . This is a "CDPHP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 200052887 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 614906 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01794247 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1268 . This is a "HNE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1059 . This is a "CDPHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1268 . This is a "HNE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 200052887 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: VT0949 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 614906 . This is a "TUFTS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com