Advanced Eyecare PC
Organization Active NPI Ophthalmology Physician · Bennington, VT
NPI 1790739340 · NPPES record last updated Jul 21, 2020
Key facts
- NPI
- 1790739340
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Ms. Tracy Niles
- Title
- Practice Administrator
- Phone
- (802) 447-8700
Practitioners 16
-
Paula Laroche, O.D.
-
Erik William Niemi, D.O.
-
Heidi H Welnak, OD
-
Pawan Bhatnagar, M.D.
-
Jonathan Huz, M.D.
-
Estela Valerian Ogiste, MD, PHD
-
David Phan, OD
-
Ryan P. Shea, O.D.
-
Michael Thomas Porter, O.D.
-
Chad P Bouchard, D.O.
-
Naomi S. Falk, M.D.
-
Kathleen S Johnson, CCC-A
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Advanced Eyecare PC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in VT, MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 - Ophthalmology |
1052301546 | Practice locations: Bennington, VT |
National Provider Directory
Locations
77 Hospital Ave
Ste 110
North Adams, MA 01247
Phone (413) 664-6736
322 Dewey St
Bennington, VT 05201
Phone (802) 447-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | VT | ||
| Ophthalmology Physician |
207W00000X | VT | Yes | |
| Ophthalmology Physician |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110072172A | Medicaid | MA | |
| ADVA318-19924 | Other | VT | VTBS |
| ADVA318-19924 | Other | MA | VTBS |
| M16004 | Other | MA | MABS |
| M16004 | Other | VT | MABS |
| VN0966 | Medicaid | VT | |
| 1059 | Other | VT | CDPHP |
| 200052887 | Other | MA | MVP |
| 614906 | Other | MA | TUFTS |
| 01794247 | Medicaid | NY | |
| 1268 | Other | VT | HNE |
| 1059 | Other | MA | CDPHP |
| 1268 | Other | MA | HNE |
| 200052887 | Other | VT | MVP |
| VT0949 | Medicaid | VT | |
| 614906 | Other | VT | TUFTS |
Other providers in Bennington, VT
- 2 Blackberry Lane Operations LLC
- Lauren Adams
- Adaptive Prosthetics & Orthotics LLC
- Katharine Thomas Addleson
- Katie Ellen Aiken
- Alan N. Binnick, M.D., P.C.
- Donna M Alexander
- Sean Alexander
- Michael Algus
All providers in Bennington, VT · Ophthalmology Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.