Provider Demographics
NPI:1730161712
Name:PIECEWICZ, THOMAS J (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:PIECEWICZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-634-8376
Mailing Address - Fax:508-634-9086
Practice Address - Street 1:115 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-634-8376
Practice Address - Fax:508-634-9086
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61204OtherFALLON COMMUNITY HEALTH P
042472266OtherTHREE RIVERS
786729OtherMVP HEALTH CARE
5168604OtherCIGNA PAL ID
5168604001OtherCIGNA HEALTH PLAN
AA2363OtherHARVARD PILGRIM HEALTHCAR
0321117OtherMEDICAID WELFARE
MA0321117Medicaid
167058OtherMEDICARE B
410045461OtherRAILROAD MEDICARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE CHAMPUS
2213114OtherFIRST HEALTH
5608218OtherAETNA US HEALTHCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
167058Medicare ID - Type Unspecified