Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 042.0007517 | VT |
NPI | 1003878349 |
---|---|
Provider Name | Mark Iverson |
First Address | Montpelier, VT 05602-3792 |
Second Address | Montpelier, VT 05602-3792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009051 | (05) | VT |
B85807 | (02) | VT |