Healthcare Provider Details

I. General information

NPI: 1184147811
Provider Name (Legal Business Name): ALYSSA CAMPAGNONE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JEFFERSON BLVD FL 3
WARWICK RI
02888
US

IV. Provider business mailing address

222 JEFFERSON BLVD FL 3
WARWICK RI
02888-3855
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-2350
  • Fax: 401-738-2744
Mailing address:
  • Phone: 401-732-2350
  • Fax: 401-738-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00664
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: