Provider Demographics
NPI:1518155167
Name:SUDARSKY, DORA (OD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:
Last Name:SUDARSKY
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 1:370 SHELBURNE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4937
Mailing Address - Country:US
Mailing Address - Phone:802-497-1676
Mailing Address - Fax:802-497-2479
Practice Address - Street 1:370 SHELBURNE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4937
Practice Address - Country:US
Practice Address - Phone:802-497-1676
Practice Address - Fax:802-497-2479
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT30-0264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022460Medicaid