Individual
MRS. MIRANDA KIRSTIN RENFROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1290 HOSPITAL DR STE 5, SAINT JOHNSBURY, VT 05819-9205
(802) 748-8126
(802) 748-2208
Mailing address
1290 HOSPITAL DR STE 5, SAINT JOHNSBURY, VT 05819-9205
(802) 748-8126
(802) 748-2208
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
032-0129313
VT
207W00000X
Ophthalmology Physician
4949
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200307490A
—
OK
01
—
OKA102503
PTAN MEDICARE
OK
Enumeration date
09/30/2008
Last updated
07/21/2022
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