Eyecare of Vermont, PLC
Organization Active NPI Optometrist · Burlington, VT
NPI 1124117973 · NPPES record last updated Mar 13, 2014
Key facts
- NPI
- 1124117973
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 030-0000338 (VT)
- Legal business name
- EYECARE OF VERMONT, PLC
- Practice address
- 230 College St
Burlington, VT 05401-8352 - Phone
- (802) 658-3330
- Fax
- (802) 658-7464
- NPI assigned
- Oct 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jon D Eriksson, O.D.
- Title
- Owner Manager
- Phone
- (802) 878-5509
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 5
-
Jon D Eriksson, OD
-
Rebecca Marie Busier, O.D.
-
Kayla Kinsley, OD
-
Jeanne A Phillip, OD
-
Taye Patterson, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051013000305 | VT | Part B Supplier - Clinic/Group Practice | 1850316399 |
Receives reassigned benefits from 5 practitioners Practice locations: Burlington, VT; Essex Junction, VT |
| O20100930053505 | VT | DME Supplier - Physician - Optometrist |
1850316399 | Practice locations: Burlington, VT |
| O20100930080263 | VT | DME Supplier - Physician - Optometrist |
1850316399 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Essex Junction, VT |
National Provider Directory
Locations
77B Pearl St
Essex Junction, VT 05452
Phone (802) 878-5509
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 030-0000338 | VT | Yes |
| Optometrist |
152W00000X | 030-0000156 | VT | |
| Low Vision Rehabilitation Optometrist |
152WL0500X | 030-0000265 | VT | |
| Low Vision Rehabilitation Optometrist |
152WL0500X | 030-0000293 | VT |
Addresses
Primary practice location
230 College St
Burlington, VT 05401-8352
Mailing address
230 College St
Burlington, VT 05401-8352
Phone (802) 658-3330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG0391 | Other | VT | RAILROAD MEDICARE |
| OVN2193 | Medicaid | VT | |
| 39218 | Other | VT | BLUECROSS/BLUESHIELD |
Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.