Healthcare Provider Details

I. General information

NPI: 1336136894
Provider Name (Legal Business Name): CARLOS R. DEFREITAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAUNCE CORNER RD SUITE 110
NORTH DARTMOUTH MA
02747-1278
US

IV. Provider business mailing address

500 FAUNCE CORNER RD SUITE 110
NORTH DARTMOUTH MA
02747-1278
US

V. Phone/Fax

Practice location:
  • Phone: 508-717-0270
  • Fax: 508-995-3060
Mailing address:
  • Phone: 508-717-0270
  • Fax: 508-995-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00461
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3839
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: