Provider Demographics
NPI:1063483030
Name:MEDEIROS, JOSEPH V JR (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:MEDEIROS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:V
Other - Last Name:MEDEIROS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:260 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2379
Practice Address - Country:US
Practice Address - Phone:508-674-7464
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393851Medicaid
MA0393851Medicaid
MA427658Medicare ID - Type Unspecified