Healthcare Provider Details

I. General information

NPI: 1245331982
Provider Name (Legal Business Name): GEORGIA PATSIOPOULOS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JEFFERSON BLVD
WARWICK RI
02888
US

IV. Provider business mailing address

222 JEFFERSON BLVD
WARWICK RI
02888-3847
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 NumberODTG00618
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: