Provider Demographics
NPI:1215007349
Name:WOLL, FREDERICK EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:EDWARD
Last Name:WOLL
Suffix:
Gender:M
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:PO BOX 956
Mailing Address - Street 2:150 PLEASANT ST
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-0016
Mailing Address - Country:US
Mailing Address - Phone:508-222-4554
Mailing Address - Fax:508-222-4555
Practice Address - Street 1:150 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-0016
Practice Address - Country:US
Practice Address - Phone:508-222-4554
Practice Address - Fax:508-222-4555
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
152029OtherHARVARD PILGRIM HEALTH CA
000000078745OtherHEALTH NET PLAN
MA755063OtherTUFTS
MA2208OtherEYE MED
MA0000028745OtherHEALTH NET
2210162OtherUNITED HEALTHCARE
0022158OtherNEIGHBORHOOD HEALTH PLAN
MAW0W15701OtherBCBS
MA0318086Medicaid
28954OtherSPECTERA VISION
30456OtherDAVIS VISION
MAW15701OtherBLUE CROSS BLUE SHIELD
MAT59029Medicare UPIN
MAW15701OtherBLUE CROSS BLUE SHIELD
MAW0W15701OtherBCBS
MA2208OtherEYE MED