Provider Demographics
NPI:1801884960
Name:BICKFORD, JOSEPH J (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:BICKFORD
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 1:64 OLD SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6094
Mailing Address - Country:US
Mailing Address - Phone:508-228-0844
Mailing Address - Fax:508-228-0491
Practice Address - Street 1:64 OLD SOUTH RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-6094
Practice Address - Country:US
Practice Address - Phone:508-228-0844
Practice Address - Fax:508-228-0491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
15075OtherHPHC
W15072OtherBCBS
MA0393525Medicaid
88670310001OtherCIGNA
NECC0844OtherVSP
00819OtherTUFTS
22-00478OtherUNITED
0003172OtherAETNA
88670310001OtherCIGNA
T59159Medicare UPIN