Healthcare Provider Details

I. General information

NPI: 1295860419
Provider Name (Legal Business Name): PRO VISION INC. DBA FEROCIOUS EYES OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 POST RD
N KINGSTOWN RI
02852-3220
US

IV. Provider business mailing address

7665 POST RD
N KINGSTOWN RI
02852-3220
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-1334
  • Fax:
Mailing address:
  • Phone: 401-295-1334
  • Fax: 401-295-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRI114
License Number StateRI

VIII. Authorized Official

Name: JOHN J LYNCH
Title or Position: OPTICIAN
Credential: R.O.
Phone: 401-295-1334