Provider Demographics
NPI:1659367472
Name:FREDDO, THOMAS F (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:FREDDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 SYLVIA'S LANE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790
Mailing Address - Country:US
Mailing Address - Phone:617-636-6107
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WATERLOO SCHOOL OF OPTOMETRY CLINICS
Practice Address - Street 2:200 UNIVERSITY AVE, WEST
Practice Address - City:WATERLOO
Practice Address - State:ONTARIO
Practice Address - Zip Code:N2L3G1
Practice Address - Country:CA
Practice Address - Phone:519-888-4567
Practice Address - Fax:519-725-0784
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA150379BMCOtherHARVARD PILGRIM HEALTH CA
MA2222316OtherAETNA
MA002578OtherTUFTS
MA0337749Medicaid
MAW15600OtherBCBS
MAW15600OtherBCBS
MA150379BMCOtherHARVARD PILGRIM HEALTH CA