1417995101 NPI number — LONARDO OPTICIANS

Table of content: (NPI 1417995101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417995101 NPI number — LONARDO OPTICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONARDO OPTICIANS
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:
1417995101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1543 SMITH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02911-2943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-353-2010
Provider Business Mailing Address Fax Number:
401-353-0380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02911-2943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-353-2010
Provider Business Practice Location Address Fax Number:
401-353-0380
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOLGO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
401-353-2010

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  OP00271 , 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: 2100005 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9923-7 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 201592 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9009923 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com