Healthcare Provider Details

I. General information

NPI: 1992756480
Provider Name (Legal Business Name): JOANNE BERNIER LICNSED OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
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: 401-841-0161
Mailing address:
  • Phone: 401-841-0966
  • Fax: 401-841-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP00296
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: