Provider Demographics
NPI:1255317830
Name:FOTI, ANTHONY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:FOTI
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 1:2 VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 JEFFERSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1963
Practice Address - Country:US
Practice Address - Phone:978-658-9512
Practice Address - Fax:978-658-3857
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3627152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356069Medicaid
MAU10210Medicare UPIN
MA0356069Medicaid