Provider Demographics
NPI:1689401150
Name:AXISMERIDIAN INC
Entity type:Organization
Organization Name:AXISMERIDIAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:DELGAUDIO
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-709-5349
Mailing Address - Street 1:463 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-3041
Mailing Address - Country:US
Mailing Address - Phone:802-442-0781
Mailing Address - Fax:802-442-0791
Practice Address - Street 1:463 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-3041
Practice Address - Country:US
Practice Address - Phone:802-442-0781
Practice Address - Fax:802-442-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty