Provider Demographics
NPI:1245496009
Name:POLSONETTI, DARINA (OD)
Entity type:Individual
Prefix:DR
First Name:DARINA
Middle Name:
Last Name:POLSONETTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DARINA
Other - Middle Name:
Other - Last Name:CELIKU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:164 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3561
Mailing Address - Country:US
Mailing Address - Phone:978-774-4500
Mailing Address - Fax:978-774-0974
Practice Address - Street 1:164 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3561
Practice Address - Country:US
Practice Address - Phone:978-774-4500
Practice Address - Fax:978-774-0974
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110114743AMedicaid
MA001022501Medicare PIN