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NPI Code Detail

MEDICARE: MARIE MANTELLI O.D.

MEDICARE: MARIE MANTELLI O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT978ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851845713
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE MANTELLI O.D.
Provider Business Mailing Address
First Line : 377 PLANTATION ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2245
Country : US
Telephone Number : 413-584-4040
Fax Number : 508-793-7858
Provider Business Practice Location Address
First Line : 377 PLANTATION ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2245
Country : US
Telephone Number : 413-584-4040
Fax Number : 508-793-7858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 10/04/2023

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