Provider Demographics
NPI:1053794123
Name:WERNER, LAURA LYNN (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:WERNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEMORIAL DR STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8320
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:
Practice Address - Street 1:128 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6058
Practice Address - Country:US
Practice Address - Phone:802-524-9561
Practice Address - Fax:802-524-6060
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0112988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025346Medicaid