Individual
DR. NICHOLAS PAUL MARCONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
166 SYCAMORE ST, SUITE 150, WILLISTON, VT 05495-8217
(802) 872-7447
(802) 872-7448
Mailing address
166 SYCAMORE ST, SUITE 150, WILLISTON, VT 05495-8217
(802) 872-7447
(802) 872-7448
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
030-0000260
VT
152WC0802X
Corneal and Contact Management Optometrist
Primary
030-0000260
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030-0000260
LICENSE NUMBER
VT
01
—
502217
ARBO OE NUMBER
VT
01
—
VT0260
EYEMED PROVIDER ID NUMBER
VT
Enumeration date
02/25/2007
Last updated
11/29/2011
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