Provider Demographics
NPI:1780053355
Name:LINDA S BOTELLO OD
Entity type:Organization
Organization Name:LINDA S BOTELLO OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-878-2020
Mailing Address - Street 1:119 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1728
Mailing Address - Country:US
Mailing Address - Phone:781-878-2020
Mailing Address - Fax:781-878-5643
Practice Address - Street 1:119 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1728
Practice Address - Country:US
Practice Address - Phone:781-878-2020
Practice Address - Fax:781-878-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty