Healthcare Provider Details

I. General information

NPI: 1750538328
Provider Name (Legal Business Name): CHRISTOPHER M COVELLO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 WINTHROP ST UNIT 2
REHOBOTH MA
02769-1200
US

IV. Provider business mailing address

492 WINTHROP ST UNIT 2
REHOBOTH MA
02769-1200
US

V. Phone/Fax

Practice location:
  • Phone: 774-901-8020
  • Fax: 774-901-8020
Mailing address:
  • Phone: 774-901-8020
  • Fax: 774-901-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4700
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00534
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: