Healthcare Provider Details

I. General information

NPI: 1447130505
Provider Name (Legal Business Name): PANGBORN PREMIER EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MAIN ST
WAKEFIELD RI
02879-3511
US

IV. Provider business mailing address

133 MAIN ST
WAKEFIELD RI
02879-3511
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8150
  • Fax: 401-783-9710
Mailing address:
  • Phone: 401-782-8150
  • Fax: 401-783-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA A PANGBORN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 401-742-6400