Healthcare Provider Details

I. General information

NPI: 1639271141
Provider Name (Legal Business Name): DIANNA HELEN AUSPRUNK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CENTER ST
RUTLAND VT
05701-4046
US

IV. Provider business mailing address

73 CENTER ST
RUTLAND VT
05701-4046
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-0424
  • Fax: 802-775-2858
Mailing address:
  • Phone: 802-773-0424
  • Fax: 802-775-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0300000274
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: