Provider Demographics
NPI:1538359328
Name:BELLO, NICHOLAS (RDO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BELLO
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4616
Mailing Address - Country:US
Mailing Address - Phone:508-798-2421
Mailing Address - Fax:508-754-9093
Practice Address - Street 1:348 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4616
Practice Address - Country:US
Practice Address - Phone:508-798-2421
Practice Address - Fax:508-754-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist