1376547851 NPI number — DR. DAVID JENNINGS O.D.

Table of content: DR. DAVID JENNINGS O.D. (NPI 1376547851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376547851 NPI number — DR. DAVID JENNINGS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1376547851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 CARONIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-450-5263
Provider Business Mailing Address Fax Number:
401-942-1783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 FALL RIVER AVE
Provider Second Line Business Practice Location Address:
NEXT TO WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
SEEKONK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02771-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-680-6732
Provider Business Practice Location Address Fax Number:
508-916-4327
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4390 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4390 . This is a "TPA OPTOMETRY LICENSE #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 469916 . This is a "TUFTS PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16381 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA15972 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0700215 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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