Healthcare Provider Details

I. General information

NPI: 1265604862
Provider Name (Legal Business Name): TOLL GATE VISION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 TOLL GATE RD STE C SUITE C
WARWICK RI
02886-0648
US

IV. Provider business mailing address

1120 TOLL GATE RD STE C
WARWICK RI
02886-0690
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-2020
  • Fax:
Mailing address:
  • Phone: 401-822-2020
  • Fax: 401-823-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00498
License Number StateRI

VIII. Authorized Official

Name: PAMELA J BLODGETT
Title or Position: PRESIDENT
Credential: DOCTOR
Phone: 401-822-2020