Provider Demographics
NPI:1225166861
Name:VELAZQUEZ VISION FIRST, INC.
Entity Type:Organization
Organization Name:VELAZQUEZ VISION FIRST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-987-1117
Mailing Address - Street 1:90 MORELAND GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1076
Mailing Address - Country:US
Mailing Address - Phone:508-450-1350
Mailing Address - Fax:508-987-3315
Practice Address - Street 1:742 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01537-1148
Practice Address - Country:US
Practice Address - Phone:508-987-1117
Practice Address - Fax:508-987-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369535Medicaid
MAW17640Medicare ID - Type Unspecified
MA0369535Medicaid