Individual
THEODORE M VITELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
65 SEA STREET EXT, HYANNIS, MA 02601-5109
(508) 775-0881
Mailing address
65 SEA STREET EXT, HYANNIS, MA 02601-5109
(508) 775-0881
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0EG000424
PA
152W00000X
Optometrist
Primary
4824
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110087501A
—
MA
Enumeration date
05/05/2006
Last updated
11/09/2017
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