Provider Demographics
NPI:1922193242
Name:AQUISTAPACE, FRANK ROBERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ROBERT
Last Name:AQUISTAPACE
Suffix:JR
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 1:15 DEER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3503
Mailing Address - Country:US
Mailing Address - Phone:802-775-0973
Mailing Address - Fax:
Practice Address - Street 1:62 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3534
Practice Address - Country:US
Practice Address - Phone:802-775-2660
Practice Address - Fax:802-775-8911
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000241152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTT86526Medicare UPIN
VTAQVT9359Medicare ID - Type Unspecified