Provider Demographics
NPI:1952704652
Name:SCARPULLA, ASHLEY DIANE
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DIANE
Last Name:SCARPULLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HOLYOKE STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615
Mailing Address - Country:US
Mailing Address - Phone:585-259-5592
Mailing Address - Fax:
Practice Address - Street 1:82 HOLYOKE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2014
Practice Address - Country:US
Practice Address - Phone:585-259-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009487-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician