Healthcare Provider Details

I. General information

NPI: 1215167879
Provider Name (Legal Business Name): JAYASREE SESHADRI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 POINT JUDITH RD SUITE #2
NARRAGANSETT RI
02882-3445
US

IV. Provider business mailing address

513 FRANCIS AVE
MANSFIELD MA
02048-1547
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-2100
  • Fax: 401-782-2101
Mailing address:
  • Phone: 781-266-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00541
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: