Provider Demographics
NPI:1912120783
Name:ROBERT J COTTER BRATTLEBORO FAMILY EYE CARE
Entity type:Organization
Organization Name:ROBERT J COTTER BRATTLEBORO FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-254-9012
Mailing Address - Street 1:328 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6240
Mailing Address - Country:US
Mailing Address - Phone:802-254-9012
Mailing Address - Fax:
Practice Address - Street 1:328 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6240
Practice Address - Country:US
Practice Address - Phone:802-254-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0819Medicaid
VT0744070001Medicare NSC
VTVN0819Medicare PIN
VTOVN0819Medicaid