Individual
KENNETH JOHN FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
9 HOPE AVE, SOUTH WALTHAM, MA 02453-2741
(781) 216-1444
Mailing address
9 HOPE AVE, WALTHAM, MA 02453-2741
(781) 216-1444
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6391
MA
156FX1800X
Optician
—
—
Other
Enumeration date
10/16/2023
Last updated
11/01/2023
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