1487974671 NPI number — LTR EYE INC.

Table of content: (NPI 1487974671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487974671 NPI number — LTR EYE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LTR EYE 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:
COVENTRY EYE CARE ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1487974671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 TIOGUE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVENTRY
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02816-5914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-828-2020
Provider Business Mailing Address Fax Number:
401-828-4482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02898-0526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-539-7900
Provider Business Practice Location Address Fax Number:
401-539-7181
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LINER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-828-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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