Basic Information
| Provider Information | |||||||||
| NPI: | 1184864019 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTPELIER EYE CARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | MONTPELIER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056023086 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | MONTPELIER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056023086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022237723 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 04/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHIPPEE | ||||||||
| AuthorizedOfficialFirstName: | KARENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8022237723 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 030-0000332 | VT | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1016698 | 05 | VT | MEDICAID |