Provider Demographics
NPI:1932315058
Name:NUNES, DOUGLAS (RDO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:NUNES
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 EARLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-1814
Mailing Address - Country:US
Mailing Address - Phone:774-526-9462
Mailing Address - Fax:508-997-6807
Practice Address - Street 1:276 EARLE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1814
Practice Address - Country:US
Practice Address - Phone:774-526-9462
Practice Address - Fax:508-997-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5325156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician