Provider Demographics
NPI:1699851220
Name:MAGALHAES, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MAGALHAES
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 1:5 WILLIAM BRADFORD CT
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3847
Mailing Address - Country:US
Mailing Address - Phone:508-725-1626
Mailing Address - Fax:508-992-3239
Practice Address - Street 1:382 STATE RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4302
Practice Address - Country:US
Practice Address - Phone:508-991-4520
Practice Address - Fax:508-992-3239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0312941Medicaid
MAU69841Medicare UPIN
MA0312941Medicaid