Provider Demographics
NPI:1194772491
Name:NIEMI, ERIK WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:WILLIAM
Last Name:NIEMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-447-8700
Mailing Address - Fax:802-447-8700
Practice Address - Street 1:322 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2225
Practice Address - Country:US
Practice Address - Phone:802-447-8700
Practice Address - Fax:802-447-1500
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219513207W00000X
VT042-0007142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110035290AMedicaid
VT10078138OtherCDPHP
VT59731OtherVT BS
VTJ26902OtherMASS BS
MAJ26902OtherMASS BS
MA364148OtherMVP
MA59731OtherVTBS
VT1010090Medicaid
VT000000027329OtherBMC
MA467617OtherTUFTS
VT467617OtherTUFTS
MA000000027330OtherBMC
MA10078138OtherCDPHP
VT33621OtherHNE
VT364148OtherMVP
VT59731OtherVT BS
VT364148OtherMVP
VTH93428Medicare UPIN
VT33621OtherHNE
VT1010090Medicaid