Provider Demographics
NPI:1124208475
Name:KOBIERECKI, JOSEPH J (RDO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:KOBIERECKI
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-0398
Mailing Address - Country:US
Mailing Address - Phone:508-478-3838
Mailing Address - Fax:508-478-8127
Practice Address - Street 1:138 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3272
Practice Address - Country:US
Practice Address - Phone:508-478-3838
Practice Address - Fax:508-478-8127
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1438156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0853830001Medicare NSC