Individual
MICHAEL THOMAS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
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
Primary
030-0000250
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024113
BMC
VT
05
—
01793535
—
NY
01
—
10001635
CDPHP
VT
05
—
1003221
—
VT
01
—
59117
MVP
VT
01
—
59302
VTBS
VT
01
—
VT0007103
TRICARE
VT
Enumeration date
06/02/2006
Last updated
03/30/2018
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