Healthcare Provider Details

I. General information

NPI: 1194276618
Provider Name (Legal Business Name): KOCH EYE ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 POST RD
NORTH KINGSTOWN RI
02852-4405
US

IV. Provider business mailing address

51 STATE RD
DARTMOUTH MA
02747-3319
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-1010
  • Fax: 401-295-2050
Mailing address:
  • Phone: 774-320-3040
  • Fax: 508-910-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: COREY B WESTERFELD
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 508-994-1400