Provider Demographics
NPI:1760548788
Name:ANZALDI, THOMAS MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:ANZALDI
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 1:427 LYNNWAY
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-3028
Mailing Address - Country:US
Mailing Address - Phone:781-599-2773
Mailing Address - Fax:781-592-7215
Practice Address - Street 1:427 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3028
Practice Address - Country:US
Practice Address - Phone:781-599-2773
Practice Address - Fax:781-592-7215
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2985OP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0345059Medicaid
111T59309Medicare UPIN
MA0345059Medicaid