1497016661 NPI number — SAMPALIS EYECARE PC

Table of content: (NPI 1497016661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497016661 NPI number — SAMPALIS EYECARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMPALIS EYECARE PC
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:
1497016661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 SCARALIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-241-9188
Provider Business Mailing Address Fax Number:
401-828-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 BALD HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-822-2050
Provider Business Practice Location Address Fax Number:
401-822-2050
Provider Enumeration Date:
06/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SAMPALIS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DR
Authorized Official Telephone Number:
401-241-9188

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MA4629 , 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: 110079003A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MS90656 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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