Healthcare Provider Details

I. General information

NPI: 1346498029
Provider Name (Legal Business Name): SIVHOUR LY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 RESERVOIR AVE
CRANSTON RI
02910-4414
US

IV. Provider business mailing address

891 WESTMINSTER ST
PROVIDENCE RI
02903-4020
US

V. Phone/Fax

Practice location:
  • Phone: 401-942-9933
  • Fax:
Mailing address:
  • Phone: 401-331-7850
  • Fax: 401-274-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4694
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTA00580
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: