NPIMap

Organization Active NPI

Advanced Eyecare PC

  • Ophthalmology Physician
  • Bennington, VT
National Provider Identifier
1790739340
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ADVANCED EYECARE PC
Practice address
322 Dewey St
Bennington, VT 05201-2225
Phone
(802) 447-8700
Fax
(802) 447-1500
NPI assigned
May 19, 2006
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Ms. Tracy Niles
Title
Practice Administrator
Phone
(802) 447-8700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X VT
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X VT Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X MA

Addresses

Primary practice location

322 Dewey St
Bennington, VT 05201-2225

Mailing address

322 Dewey St
Bennington, VT 05201-2225
Phone (802) 447-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, MA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040517000358 VT Part B Supplier - Clinic/Group Practice 1052301546 Receives reassigned benefits from 11 practitioners
Practice locations: Bennington, VT; Manchester Center, VT
O20071130000355 VT Part B Supplier - Clinic/Group Practice 1052301546 Receives reassigned benefits from 4 practitioners
Practice locations: Bennington, VT; Manchester Center, VT
O20080626000070 MA Part B Supplier - Clinic/Group Practice 1052301546 Receives reassigned benefits from 5 practitioners
Practice locations: N Adams, MA
O20100930040185 VT DME Supplier - Physician - OphthalmologyDME Supplier - Optician 1052301546 Practice locations: Bennington, VT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Advanced Eyecare PC322 Dewey St, Bennington, VT 05201-2225(802) 447-8700 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Oct 17, 1994

National Provider Directory

National Provider Directory

Locations

322 Dewey St
Bennington, VT 05201
Phone (802) 447-8700

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1790739340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DEWEY ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012225",
            "telephone_number": "802-447-8700",
            "fax_number": "802-447-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 DEWEY ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012225",
            "telephone_number": "802-447-8700",
            "fax_number": "802-447-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "NILES",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "802-447-8700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "VT",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "VT",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.