Provider Demographics
NPI:1619232246
Name:COVELLO, DOMENIC ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:ANTHONY
Last Name:COVELLO
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 1:382 COLE ST
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5812
Mailing Address - Country:US
Mailing Address - Phone:508-612-7269
Mailing Address - Fax:
Practice Address - Street 1:1250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6227
Practice Address - Country:US
Practice Address - Phone:508-717-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4915152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist