Provider Demographics
NPI:1144301961
Name:OPTICAL EXPRESSIONS, INC.
Entity type:Organization
Organization Name:OPTICAL EXPRESSIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-748-3536
Mailing Address - Street 1:282 BERLIN MALL RD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8292
Mailing Address - Country:US
Mailing Address - Phone:802-223-2090
Mailing Address - Fax:802-223-5336
Practice Address - Street 1:282 BERLIN MALL RD
Practice Address - Street 2:UNIT 4
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8292
Practice Address - Country:US
Practice Address - Phone:802-223-2090
Practice Address - Fax:802-223-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1309010002OtherDMERC SUPPLIER NUMBER