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General NPI Number Information
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NPI Number | 1659367472
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Entity Type | Individual
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Provider Name | THOMAS F FREDDO OD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF WATERLOO SCHOOL OF OPTOMETRY CLINICS 200 UNIVERSITY AVE, WEST
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City | WATERLOO
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State | ONTARIO
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Zip | N2L3G1
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Country | CA
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Telephone | 519-888-4567
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Fax | 519-725-0784
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Provider Business Mailing Address
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Address Line | 116 SYLVIA'S LANE
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City | WESTPORT
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State | MA
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Zip | 02790
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Country | US
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Telephone | 617-636-6107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2578
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License Number State | MA
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