Provider Demographics
NPI:1760417273
Name:YAMPOLSKY, VICTORIA S (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:YAMPOLSKY
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 1:612 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3032
Mailing Address - Country:US
Mailing Address - Phone:781-828-2212
Mailing Address - Fax:781-828-1771
Practice Address - Street 1:612 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3032
Practice Address - Country:US
Practice Address - Phone:781-828-2212
Practice Address - Fax:781-828-1771
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA7142OtherHARVARD PILGRIM
MA2201168OtherUNITED HEALTHCARE
MA9941241OtherAETNA
MA0181650Medicaid
MAW16325OtherBLUE CROSS/BLUE SHIELD
MA2201168OtherUNITED HEALTHCARE
U91297Medicare UPIN