Healthcare Provider Details

I. General information

NPI: 1871543868
Provider Name (Legal Business Name): EYE-SHOP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE SUITE 240
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

1524 ATWOOD AVE SUITE 240
JOHNSTON RI
02919-3228
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-6450
  • Fax: 401-272-0388
Mailing address:
  • Phone: 401-351-6450
  • Fax: 401-272-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateRI

VIII. Authorized Official

Name: DR. WILLIAM J ANDREONI
Title or Position: OWNER
Credential: MD
Phone: 401-351-6450