Provider Demographics
NPI:1457445876
Name:VINAGRE, MICHELLE DEANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DEANNE
Last Name:VINAGRE
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 1:7 GINNY'S DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770
Mailing Address - Country:US
Mailing Address - Phone:508-763-8165
Mailing Address - Fax:
Practice Address - Street 1:3003-B CRANBERRY HWY.
Practice Address - Street 2:
Practice Address - City:E. WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538
Practice Address - Country:US
Practice Address - Phone:508-295-2661
Practice Address - Fax:508-295-2774
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0313475Medicaid
MAU86085Medicare UPIN
MA0313475Medicaid