# NORTHWESTERN MEDICAL CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northwestern Ophthalmology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760748693
- **Authorized official:** MARY E PIGEON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (802) 524-8954

## Contact information

- **Practice address:** 128 FISHER POND RD, 2ND FLOOR, SUITE 3, SAINT ALBANS, VT 05478-6058
- **Practice address phone:** (802) 752-1921
- **Practice address fax:** (802) 752-1356
- **Mailing address:** 128 FISHER POND ROAD, 2ND FLOOR, SUITE 3, SAINT ALBANS, VT 05478-4405
- **Mailing address phone:** (802) 752-1921
- **Mailing address fax:** (802) 752-1356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/04/2012
- **Last updated:** 10/23/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1020384 | — | VT |