Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenneth John Fazio, LDO

Individual provider Optician · NPI 1457133308

Kenneth John Fazio, LDO is an Optician in South Waltham, Massachusetts. Practices as a sole proprietor. Licensed in Massachusetts.

Licensed in
MA
In the registry since
2023
Specialties on file
2

Practice location Address checks out

9 Hope Ave
South Waltham, MA 02453-2741
Phone: (781) 216-1444
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optician (primary) Taxonomy 156FX1800X · Licence 6391 (MA)
Optician Taxonomy 156FX1800X

Record details

NPI number1457133308
Entity typeIndividual (Type 1)
GenderMale
Credentials LDO
Sole proprietorYes
NPI enumeratedOctober 16, 2023
Last updated in NPPESNovember 1, 2023
Certification dateNovember 1, 2023