1922195890 NPI number — CUMBERLAND FAMILY EYE CARE, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922195890 NPI number — CUMBERLAND FAMILY EYE CARE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND FAMILY EYE CARE, LTD.
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:
6
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:
1922195890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 WAMPANOAG TRL
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02915-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-435-5555
Provider Business Mailing Address Fax Number:
401-431-5906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 WAMPANOAG TRAIL
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-435-5555
Provider Business Practice Location Address Fax Number:
401-431-5906
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTOS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
401-435-5555

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)

  • Identifier: CF00226 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: EP00226 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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