Provider Demographics
NPI:1447549878
Name:NELL R. NAIDETH, OD
Entity type:Organization
Organization Name:NELL R. NAIDETH, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAIDETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-342-1837
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-0309
Mailing Address - Country:US
Mailing Address - Phone:978-342-1837
Mailing Address - Fax:508-484-2008
Practice Address - Street 1:285 MAIN ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4303
Practice Address - Country:US
Practice Address - Phone:978-342-1837
Practice Address - Fax:508-484-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty