1407980352 NPI number — EASTERN VISION GROUP

Table of content: (NPI 1407980352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407980352 NPI number — EASTERN VISION GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN VISION GROUP
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:
1407980352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1388 MINERAL SPRING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02904-4649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-353-3230
Provider Business Mailing Address Fax Number:
401-353-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1388 MINERAL SPRING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-353-3230
Provider Business Practice Location Address Fax Number:
401-353-3236
Provider Enumeration Date:
03/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWENSON
Authorized Official First Name:
NORMAANN
Authorized Official Middle Name:
GERALDINE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-353-3230

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OTDG00506 , 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: 2200239 . This is a "UNITED HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 872 . This is a "DAVIS VISION" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 79387 . This is a "BLUE CROSSBLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2877 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".