Provider Demographics
NPI:1750538328
Name:COVELLO, CHRISTOPHER M (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:COVELLO
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 1:492 WINTHROP ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1200
Mailing Address - Country:US
Mailing Address - Phone:774-901-8020
Mailing Address - Fax:774-901-8020
Practice Address - Street 1:492 WINTHROP ST UNIT 2
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1200
Practice Address - Country:US
Practice Address - Phone:774-901-8020
Practice Address - Fax:774-901-8020
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4700152W00000X
RIODTG00534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000735801Medicare PIN
RI007060931Medicare PIN