Provider Demographics
NPI:1366606055
Name:BOISVERT, CHANTAL JOSEE (OD, MD)
Entity type:Individual
Prefix:DR
First Name:CHANTAL
Middle Name:JOSEE
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:OD, MD
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Other - Credentials:
Mailing Address - Street 1:2351 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:919-681-9191
Mailing Address - Fax:199-684-0547
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0017057207W00000X
CAA104628207W00000X, 207WX0109X, 207WX0110X
NC2019-01326207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AN361ZMedicare PIN