Provider Demographics
NPI:1134119217
Name:DUMONT, VICTORIA L (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:DUMONT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:719 NEW SHERBORN ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331
Mailing Address - Country:US
Mailing Address - Phone:978-669-4094
Mailing Address - Fax:978-632-1962
Practice Address - Street 1:677 TIMPANY BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-669-4094
Practice Address - Fax:978-632-1962
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110017590AMedicaid
MA0369144Medicaid
MA0369144Medicaid
U53835Medicare UPIN
MAMD0360393MOtherDEA