Provider Demographics
NPI:1669417010
Name:HASTIE, SHEILA L (OD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:L
Last Name:HASTIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0325
Mailing Address - Country:US
Mailing Address - Phone:802-222-4543
Mailing Address - Fax:802-222-4503
Practice Address - Street 1:165 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1509
Practice Address - Country:US
Practice Address - Phone:603-678-8185
Practice Address - Fax:603-678-8194
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-11-08
Deactivation Date:2018-10-30
Deactivation Code:
Reactivation Date:2018-11-07
Provider Licenses
StateLicense IDTaxonomies
VTVT0300000269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023472Medicaid
VTVN1343Medicare PIN
VT1009878Medicaid