Provider Demographics
NPI:1396718839
Name:MASELLI, THOMAS R (OD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:MASELLI
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 1:151 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247
Mailing Address - Country:US
Mailing Address - Phone:413-662-2020
Mailing Address - Fax:413-662-2908
Practice Address - Street 1:151 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-662-2020
Practice Address - Fax:413-662-2908
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2931152W00000X
VT201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0341827Medicaid
MA0341827Medicaid
T59293Medicare UPIN