Provider Demographics
NPI:1316933583
Name:NORTHEAST VISION CENTER, PC
Entity type:Organization
Organization Name:NORTHEAST VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARENTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-334-1515
Mailing Address - Street 1:5452 US ROUTE 5
Mailing Address - Street 2:STE H
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9870
Mailing Address - Country:US
Mailing Address - Phone:802-334-1515
Mailing Address - Fax:802-334-2935
Practice Address - Street 1:5452 US ROUTE 5
Practice Address - Street 2:STE H
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9870
Practice Address - Country:US
Practice Address - Phone:802-334-1515
Practice Address - Fax:802-334-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000278261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTDA8993OtherRR MCR GROUP
VT68799OtherBC GROUP NUMBER
VTVN2995Medicare ID - Type Unspecified
VTDA8993OtherRR MCR GROUP
VTU68848Medicare UPIN