Provider Demographics
NPI:1164620936
Name:ALFRED, FRED L (DO)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:L
Last Name:ALFRED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2441
Mailing Address - Country:US
Mailing Address - Phone:508-222-8013
Mailing Address - Fax:508-226-4228
Practice Address - Street 1:174 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2441
Practice Address - Country:US
Practice Address - Phone:508-222-8013
Practice Address - Fax:508-226-4228
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4873156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA102058OtherSUPPLIER NUMBER
MA0125610001OtherMEDICARE SUPPLIER NUMBER