Healthcare Provider Details

I. General information

NPI: 1205491941
Provider Name (Legal Business Name): CORY JEAN LAWRENCE-FISHER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC NEW ENGLAND 43 SMITH ROAD, BLDG 23
NEWPORT RI
02841
US

IV. Provider business mailing address

43 SMITH RD BLDG 23
NEWPORT RI
02841-1006
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-3666
  • Fax: 401-841-6709
Mailing address:
  • Phone: 401-841-3666
  • Fax: 401-841-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSE33TAB59
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: