Provider Demographics
NPI:1275551863
Name:VELAZQUEZ, FERDINAND (OD)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:VELAZQUEZ
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 1:90 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV08918Medicare UPIN