Provider Demographics
NPI:1235235417
Name:BOTELHO, NANCY I (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:
Last Name:BOTELHO
Suffix:I
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1000
Mailing Address - Country:US
Mailing Address - Phone:508-673-2020
Mailing Address - Fax:508-672-9568
Practice Address - Street 1:933 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1000
Practice Address - Country:US
Practice Address - Phone:508-673-2020
Practice Address - Fax:508-672-9568
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5876156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician