# ADVANCED EYECARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790739340
- **Authorized official:** MS. TRACY NILES (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (802) 447-8700

## Contact information

- **Practice address:** 322 DEWEY ST, BENNINGTON, VT 05201-2225
- **Practice address phone:** (802) 447-8700
- **Practice address fax:** (802) 447-1500
- **Mailing address:** 322 DEWEY ST, BENNINGTON, VT 05201-2225
- **Mailing address phone:** (802) 447-8700
- **Mailing address fax:** (802) 447-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | VT | — |
| 207W00000X | Ophthalmology Physician | — | MA | — |
| 207W00000X | Ophthalmology Physician | — | VT | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 07/21/2020

## 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 |