NPIMap

Organization Active NPI

White River Family Eyecare, PC

  • Optometrist
  • White River Junction, VT
National Provider Identifier
1104878206
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VT030-0000220 Issued in VT
Legal business name
WHITE RIVER FAMILY EYECARE, PC
Practice address
587 Hartford Ave
White River Junction, VT 05001-8031
Phone
(802) 295-4887
Fax
(802) 295-5896
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eugene J Bernal, O.D.NPI 1902841380
Title
President
Phone
(802) 295-4887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X VT030-0000220 VT Primary

Addresses

Primary practice location

587 Hartford Ave
White River Junction, VT 05001-8031

Mailing address

587 Hartford Ave
White River Junction, VT 05001-8031
Phone (802) 295-4887

Other identifiers 1

IdentifierTypeStateIssuer
1009878MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060712000152 VT Part B Supplier - Clinic/Group Practice 7911910096 Receives reassigned benefits from 7 practitioners
Practice locations: White River Junction, VT
O20130913000486 NH Part B Supplier - Clinic/Group Practice 7911910096 Receives reassigned benefits from 3 practitioners
Practice locations: Hanover, NH

National Provider Directory

National Provider Directory

Locations

842 Hartford Ave
White Riv JCT, VT 05001
Phone (802) 295-4887

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1104878206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 HARTFORD AVE",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050018031",
            "telephone_number": "802-295-4887",
            "fax_number": "802-295-5896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 HARTFORD AVE",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050018031",
            "telephone_number": "802-295-4887",
            "fax_number": "802-295-5896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER FAMILY EYECARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "BERNAL",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-295-4887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VT",
            "license": "VT030-0000220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009878",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White River Junction, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.