Provider Demographics
NPI:1336136894
Name:DEFREITAS, CARLOS R (OD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:DEFREITAS
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 1:500 FAUNCE CORNER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1278
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-995-3060
Practice Address - Street 1:500 FAUNCE CORNER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1278
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:508-995-3060
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00461152W00000X
MA3839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369969Medicaid
RI9007998Medicaid
MAW16157OtherB/C B/S OF MASS
RI410044460Medicare PIN
MAW26006Medicare PIN
MAW16157OtherB/C B/S OF MASS
RI9007998Medicaid