Herbert T Black, O.D.
Individual provider Active NPI Optometrist · Brattleboro, VT
NPI 1265439723 · NPPES record last updated Nov 10, 2011
Key facts
- NPI
- 1265439723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2081 (CO)
- Practice address
- 1222 Putney Rd
Brattleboro, VT 05301-9000 - Phone
- (802) 254-6900
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030.0069859 | VT | MD | Optometrist |
| 2081 | CO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2081 | CO | Yes |
| Optometrist | 152W00000X | 030.0069859 | VT |
Addresses
Primary practice location
1222 Putney Rd
Brattleboro, VT 05301-9000
Mailing address
3098 S Ivan Way
Denver, CO 80227-3838
Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.