1215007349 NPI number — FREDERICK EDWARD WOLL OD

Table of content: FREDERICK EDWARD WOLL OD (NPI 1215007349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215007349 NPI number — FREDERICK EDWARD WOLL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLL
Provider First Name:
FREDERICK
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215007349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 956
Provider Second Line Business Mailing Address:
150 PLEASANT ST
Provider Business Mailing Address City Name:
ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-222-4554
Provider Business Mailing Address Fax Number:
508-222-4555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-222-4554
Provider Business Practice Location Address Fax Number:
508-222-4555
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MA2208 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 152029 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000078745 . This is a "HEALTH NET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 755063 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MA2208 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000028745 . This is a "HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2210162 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0022158 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: W0W15701 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0318086 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28954 . This is a "SPECTERA VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30456 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15701 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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