MEDICARE: DR. DOMENIC ANTHONY COVELLO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4915	MA

General Provider Information

NPI Number	:	1619232246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMENIC ANTHONY COVELLO OD

Provider Business Mailing Address
First Line	:	382 COLE ST
Second Line	:
City	:	SEEKONK
State	:	MA
Zip	:	02771-5812
Country	:	US
Telephone Number	:	508-612-7269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 S WASHINGTON ST
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-6227
Country	:	US
Telephone Number	:	508-717-0425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	06/05/2014

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