Healthcare Provider Details

I. General information

NPI: 1154375418
Provider Name (Legal Business Name): PAUL ZERBINOPOULOS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 VILLAGE SQUARE DR
SOUTH KINGSTOWN RI
02879-8274
US

IV. Provider business mailing address

55 VILLAGE SQUARE DR
SOUTH KINGSTOWN RI
02879-8274
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2020
  • Fax: 401-789-4113
Mailing address:
  • Phone: 401-272-2020
  • Fax: 401-789-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00416
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3465
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: