Provider Demographics
NPI:1669427407
Name:LAROCHE, PAULA (OD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:LAROCHE
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 1:322 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-447-8700
Mailing Address - Fax:802-447-1500
Practice Address - Street 1:322 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2225
Practice Address - Country:US
Practice Address - Phone:802-447-8700
Practice Address - Fax:802-447-1500
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59302OtherVTBS
VT410049539OtherRR MCRP
VT361194OtherMVP
VTOVN2992Medicaid
NY02360947Medicaid
VT0965940001OtherDMERC
VT10063061OtherCDPHP
VT59302OtherVTBS
VTU91541Medicare UPIN