Provider Demographics
NPI:1548263981
Name:DONATELLE, JOSEPH R (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:DONATELLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1770
Mailing Address - Country:US
Mailing Address - Phone:413-782-5339
Mailing Address - Fax:413-782-3050
Practice Address - Street 1:1268 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1770
Practice Address - Country:US
Practice Address - Phone:413-782-5339
Practice Address - Fax:413-782-3050
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2204082OtherUNITED HEALTH CARE
MA762249OtherTUFTS
MA207500OtherCONNECTICARE
MAW15240OtherBLUE CROSS BLUE SHIELD
MA1207562002OtherCIGNA
MA5098016OtherAETNA
MA0309001Medicaid
MA604061OtherUS HEALTHCARE
MA988410OtherNETWORK HEALTH
MAT59001OtherPIONEER
MA0012291OtherNIEGHBORHOOD HEALTH PLAN
MA11873OtherHEALTH NEW ENGLAND
MAT59001Medicare UPIN
MAP00018162Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MADO049458Medicare ID - Type Unspecified
MA04945801Medicare PIN