Provider Demographics
NPI:1851490312
Name:SANTOS, GEORGE AUGUSTUS JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:AUGUSTUS
Last Name:SANTOS
Suffix:JR
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:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0327
Mailing Address - Country:US
Mailing Address - Phone:508-693-7222
Mailing Address - Fax:508-693-8739
Practice Address - Street 1:638 MAIN ST.
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-0327
Practice Address - Country:US
Practice Address - Phone:508-693-7222
Practice Address - Fax:508-693-8739
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353647Medicaid
MA0353647Medicaid