Provider Demographics
NPI:1689752552
Name:DAPOLITO, DANIEL MARCO (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARCO
Last Name:DAPOLITO
Suffix:
Gender:M
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 ST
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 ST
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:2006-11-01
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18678OtherBLUE CROSS BLUE SHIELD
593022OtherMNP
18678OtherBLUE CROSS BLUE SHIELD
0VN0363Medicare ID - Type Unspecified