Healthcare Provider Details

I. General information

NPI: 1265263594
Provider Name (Legal Business Name): THOMAS ROBERT RICCIUTTI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BOSTON RD
BILLERICA MA
01821-5316
US

IV. Provider business mailing address

26 KESSLER FARM DR APT 418
NASHUA NH
03063-7134
US

V. Phone/Fax

Practice location:
  • Phone: 978-667-0481
  • Fax:
Mailing address:
  • Phone: 401-573-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8424
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: