Basic Information
| Provider Information | |||||||||
| NPI: | 1003806167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAPOSO | ||||||||
| FirstName: | FATIMA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1565 N MAIN ST | ||||||||
| Address2: | STE 406 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027202972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086770041 | ||||||||
| FaxNumber: | 5086770975 | ||||||||
| Practice Location | |||||||||
| Address1: | 1565 N MAIN ST | ||||||||
| Address2: | STE 406 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027202972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086770041 | ||||||||
| FaxNumber: | 5086770975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 11/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4022 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0372081 | 05 | MA | MEDICAID |