Provider Demographics
NPI:1700935145
Name:WOLOSINSKI, MONICA LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LEWIS
Last Name:WOLOSINSKI
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 1:91 MAIN ST
Mailing Address - Street 2:P.O. BOX 68
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1335
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:05753-1335
Practice Address - Country:US
Practice Address - Phone:802-388-2811
Practice Address - Fax:802-388-8265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59474OtherBCBS
VT364702OtherMVP
VT1009803Medicaid
VT364702OtherMVP
VT1009803Medicaid