Provider Demographics
NPI:1366419897
Name:EYE ASSOCIATES OF NORTHERN NEW ENGLAND
Entity type:Organization
Organization Name:EYE ASSOCIATES OF NORTHERN NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-748-8126
Mailing Address - Street 1:1290 HOSPITAL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9239
Mailing Address - Country:US
Mailing Address - Phone:802-748-8126
Mailing Address - Fax:802-748-2208
Practice Address - Street 1:1290 HOSPITAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9239
Practice Address - Country:US
Practice Address - Phone:802-748-8126
Practice Address - Fax:802-748-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5116070001Medicare ID - Type Unspecified
VT5116070002Medicare ID - Type Unspecified