Provider Demographics
NPI:1013900745
Name:FABELLO, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:FABELLO
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 1:159 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1923
Mailing Address - Country:US
Mailing Address - Phone:978-459-6262
Mailing Address - Fax:978-458-0358
Practice Address - Street 1:159 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1923
Practice Address - Country:US
Practice Address - Phone:978-459-6262
Practice Address - Fax:978-458-0358
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0344206Medicaid
MA979552OtherNETWORK HEALTH
MA151299OtherHARVARD PILGRIM
MAW15680OtherBLUE CROSS BLUE SHIELD
MA115581OtherEYEMED
MA0004866OtherNEIGHBORHOOD HEALTH PLAN
MA0339008Medicaid
MA469330OtherTUFTS TOTAL HEALTH PLAN
MA115581OtherEYEMED