Provider Demographics
NPI:1093884942
Name:DAPOLITO, DIANE A (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:A
Last Name:DAPOLITO
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 1:91 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-2811
Mailing Address - Fax:802-388-8265
Practice Address - Street 1:91 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-2811
Practice Address - Fax:802-388-8265
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT300000244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0364Medicaid
59V023OtherMVP
18677OtherBCBS
U31734Medicare UPIN
0VN0364Medicare ID - Type Unspecified