Provider Demographics
NPI:1699868778
Name:VASILAKOS, LAURA A (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:VASILAKOS
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 1:27 RAILROAD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3877
Mailing Address - Country:US
Mailing Address - Phone:781-934-6945
Mailing Address - Fax:781-934-1351
Practice Address - Street 1:27 RAILROAD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3877
Practice Address - Country:US
Practice Address - Phone:781-934-6945
Practice Address - Fax:781-934-1351
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16466OtherBC/BS
MA4553OtherMA OPTOMETRY LICENSE
MAMV0616005MOtherCONTROLLED SUBSTANCE
MAMV0616005MOtherCONTROLLED SUBSTANCE
MAW1763601Medicare PIN