Michael Thomas Porter, O.D.
Individual provider Active NPI Optometrist · Bennington, VT
NPI 1043258262 · NPPES record last updated Mar 30, 2018
Key facts
- NPI
- 1043258262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 030-0000250 (VT)
- Practice address
- 322 Dewey St
Bennington, VT 05201-2225 - Phone
- (802) 447-8700
- Fax
- (802) 447-1500
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060321000711 | VT | Practitioner - Optometry | 4880601566 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030-0000250 | VT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Eyecare PC | Optometrist | Current |
Accepting new patients |
Locations
322 Dewey St
Bennington, VT 05201
Phone (802) 447-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 030-0000250 | VT | Yes |
Addresses
Primary practice location
322 Dewey St
Bennington, VT 05201-2225
Mailing address
322 Dewey St
Bennington, VT 05201-2225
Phone (802) 447-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 59302 | Other | VT | VTBS |
| 01793535 | Medicaid | NY | |
| 10001635 | Other | VT | CDPHP |
| 1003221 | Medicaid | VT | |
| 000000024113 | Other | VT | BMC |
| VT0007103 | Other | VT | TRICARE |
| 59117 | Other | VT | MVP |
Other providers in Bennington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.