1407853997 NPI number — PAMELA J BLODGETT O.D.

Table of content: PAMELA J BLODGETT O.D. (NPI 1407853997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407853997 NPI number — PAMELA J BLODGETT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLODGETT
Provider First Name:
PAMELA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1407853997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 TOLL GATE RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-0648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-822-2020
Provider Business Mailing Address Fax Number:
401-823-5852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 TOLLGATE ROAD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-822-2020
Provider Business Practice Location Address Fax Number:
401-823-5852
Provider Enumeration Date:
06/30/2005

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:  ODTA00417 , 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: 0129360001 . This is a "MEDCIARE DME" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 999995218 . This is a "VISION SERVICE PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9007934 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9924-6 . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 203400 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2816 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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