Healthcare Provider Details

I. General information

NPI: 1700849593
Provider Name (Legal Business Name): EYE HEALTH VISION CENTER OF RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

73 VALLEY RD
MIDDLETOWN RI
02842-5234
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-0966
  • Fax: 401-841-0966
Mailing address:
  • Phone: 401-841-0966
  • Fax: 401-841-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN F SULLIVAN
Title or Position: OWNER/ PHYSICIAN
Credential: M.D.
Phone: 508-994-1400