Healthcare Provider Details

I. General information

NPI: 1932887262
Provider Name (Legal Business Name): ANNA SORENSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 TIOGUE AVE
COVENTRY RI
02816-5914
US

IV. Provider business mailing address

860 TIOGUE AVE
COVENTRY RI
02816-5914
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-2020
  • Fax:
Mailing address:
  • Phone: 401-828-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG0P780
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: