Healthcare Provider Details

I. General information

NPI: 1598700924
Provider Name (Legal Business Name): SANDRA K. DUFOUR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 HARTFORD AVE
WHITE RIVER JUNCTION VT
05001-8031
US

IV. Provider business mailing address

587 HARTFORD AVE
WHITE RIVER JUNCTION VT
05001-8031
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-4887
  • Fax: 802-295-5896
Mailing address:
  • Phone: 802-295-4887
  • Fax: 802-295-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVT0300000314
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: