1760528962 NPI number — OPHTHALMOLOGY INC

Table of content: (NPI 1760528962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760528962 NPI number — OPHTHALMOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
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:
THE RHODE ISLAND EYE INSTITUTE
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:
1760528962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 HANOVER ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720-5246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-679-0150
Provider Business Mailing Address Fax Number:
508-324-9085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 E MANNING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-272-2020
Provider Business Practice Location Address Fax Number:
401-421-5979
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUELL
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ACCOUNTS MANAGER
Authorized Official Telephone Number:
401-272-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0012176 . This is a "NEIGHBORHOOD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 613531 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9782486 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17024 . This is a "MASS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 42363 . This is a "RI BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9001520 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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