Healthcare Provider Details

I. General information

NPI: 1255317830
Provider Name (Legal Business Name): ANTHONY JOSEPH FOTI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON RD SUITE 102
WILMINGTON MA
01887-1963
US

IV. Provider business mailing address

2 VICTORIA LN
STONEHAM MA
02180-2221
US

V. Phone/Fax

Practice location:
  • Phone: 978-658-9512
  • Fax: 978-658-3857
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3627
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: