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Organization
ADVANCED EYECARE PC
Active
Organization
ADVANCED EYECARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY NILES (PRACTICE ADMINISTRATOR)
(802) 447-8700
Entity
Organization
Contact information
Practice address
322 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-8700
(802) 447-1500
Mailing address
322 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-8700
(802) 447-1500
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
VT
207W00000X
Ophthalmology Physician
—
MA
207W00000X
Ophthalmology Physician
Primary
—
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01794247
—
NY
01
—
1059
CDPHP
MA
01
—
1059
CDPHP
VT
05
—
110072172A
—
MA
01
—
1268
HNE
MA
01
—
1268
HNE
VT
01
—
200052887
MVP
MA
01
—
200052887
MVP
VT
01
—
614906
TUFTS
MA
01
—
614906
TUFTS
VT
01
—
ADVA318-19924
VTBS
MA
01
—
ADVA318-19924
VTBS
VT
01
—
M16004
MABS
MA
01
—
M16004
MABS
VT
05
—
VN0966
—
VT
05
—
VT0949
—
VT
Enumeration date
05/19/2006
Last updated
07/21/2020
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