1003911967 NPI number — KENT OPHTHALMOLOGY, INC.

Table of content: (NPI 1003911967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003911967 NPI number — KENT OPHTHALMOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT OPHTHALMOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003911967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 TOLL GATE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-732-6640
Provider Business Mailing Address Fax Number:
401-739-5265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 TOLL GATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-6640
Provider Business Practice Location Address Fax Number:
401-739-5265
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VARR
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-732-6640

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  6734 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000002956 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1133 . This is a "NEIGHBORHOOD HEALTH PLANS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 616049 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9002956 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34247 . This is a "DAVIS VISION" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AA40708 . This is a "HARVARD PILGRIM HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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