1427041136 NPI number — DR. OSCAR W NI O.D.

Table of content: DR. OSCAR W NI O.D. (NPI 1427041136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427041136 NPI number — DR. OSCAR W NI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NI
Provider First Name:
OSCAR
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1427041136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1563 FALL RIVER AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEEKONK
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02771-3736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-336-0576
Provider Business Mailing Address Fax Number:
508-916-3752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1563 FALL RIVER AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEEKONK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02771-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-336-0576
Provider Business Practice Location Address Fax Number:
508-916-3752
Provider Enumeration Date:
08/26/2005

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: 152WC0802X , with the licence number:  MA 4010 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2089824 . This is a "FIRST HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0312541 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402686 . This is a "BLUECHIP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 152355 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20568-1 . This is a "BCBS RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2200361 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3011179 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 48668 . This is a "DAVIS VISION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16125 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 03693 . This is a "SPECTERA VISION PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B211081001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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