1568613784 NPI number — JENNINGS EYECARE INC.

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 1568613784 NPI number — JENNINGS EYECARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNINGS EYECARE INC.
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:
1568613784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 CARONIA ST
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:
02920-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-450-5263
Provider Business Mailing Address Fax Number:
508-916-4327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 FALL RIVER AVE
Provider Second Line Business Practice Location Address:
NEXT TO WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
SEEKONK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02771-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-680-6732
Provider Business Practice Location Address Fax Number:
508-916-4327
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JENNINGS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, JENNINGS EYECARE INC.
Authorized Official Telephone Number:
401-450-5263

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4390 , 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: 29174-1 . This is a "BC/BS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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